{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T05:05:14Z","timestamp":1789621514479,"version":"build-2803163510"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008233","name":"Shanghai Jiao Tong University School of Medicine","doi-asserted-by":"publisher","award":["TQ-0133-00-0062"],"award-info":[{"award-number":["TQ-0133-00-0062"]}],"id":[{"id":"10.13039\/501100008233","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Evidence supporting first-line cryoballoon ablation (CBA) in treatment-naive persistent atrial fibrillation (PersAF) is limited. Consequently, we compared CBA with guideline-directed antiarrhythmic drug (AAD) therapy in this advanced form of disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>This multicentre, prospective, randomized, open-label trial assigned 320 symptomatic, treatment-naive patients with PersAF (1:1) to CBA or AAD therapy. The primary endpoint was the first documented atrial tachyarrhythmia recurrence lasting at least 30\u2005s during days 91\u2013365. Secondary endpoints included recurrence during days 1\u201390 and 1\u2013365, time-to-first recurrence, quality of life, and safety. In the intention-to-treat population, recurrence during days 91\u2013365 occurred in 30\/160 (18.8%) patients assigned to CBA and 71\/160 (44.4%) assigned to AAD therapy (absolute difference, \u221225.6 percentage points; 95% confidence interval, \u221235.4 to \u221215.8; P &amp;lt; 0.001). Supportive time-to-event analysis favoured CBA (hazard ratio for AAD vs. CBA, 2.29; 95% confidence interval, 1.48\u20133.56; log-rank P &amp;lt; 0.001). In CBA vs. AAD comparisons, overall recurrence during days 1\u2013365 was 23.8% vs. 55.6%, and early recurrence was 11.2% vs. 28.1% (both P &amp;lt; 0.001; respectively). Improvement in AFEQT score was greater with CBA (17.3 vs. 6.6 points; P &amp;lt; 0.001), whereas SF-12 component scores did not differ significantly. Adverse events recorded on event forms were infrequent in both cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In selected treatment-naive patients with PersAF, first-line CBA reduced atrial tachyarrhythmia recurrence and improved disease-specific quality of life compared with AAD therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov, NCT04942834.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euag230","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T10:29:45Z","timestamp":1788258585000},"source":"Crossref","is-referenced-by-count":0,"title":["Cryoballoon ablation vs. antiarrhythmic drug therapy as initial treatment for persistent atrial fibrillation:\n                    <i>the multicentre randomized CEPAF trial<\/i>"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8079-5490","authenticated-orcid":false,"given":"Tianyou","family":"Ling","sequence":"first","affiliation":[{"name":"Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , 197 Ruijin Second Road, Shanghai 200025 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yazhou","family":"Lin","sequence":"additional","affiliation":[{"name":"Shengli Clinical Medical College of Fujian Medical University, Fuzhou University Affiliated Provincial Hospital , Fuzhou ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6847-6393","authenticated-orcid":false,"given":"Yangyang","family":"Bao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , 197 Ruijin Second Road, Shanghai 200025 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Chen","sequence":"additional","affiliation":[{"name":"Shengli Clinical Medical College of Fujian Medical University, Fuzhou University Affiliated Provincial Hospital , Fuzhou ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3657-1246","authenticated-orcid":false,"given":"Wei","family":"Xu","sequence":"additional","affiliation":[{"name":"Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School , 321 Zhongshan Road, Nanjing 210008, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4845-8091","authenticated-orcid":false,"given":"Baopeng","family":"Tang","sequence":"additional","affiliation":[{"name":"Cardiac Pacing and Electrophysiology Department, Xinjiang Key Laboratory of Cardiac Electrophysiology and Cardiac Remodeling, The First Affiliated Hospital of Xinjiang Medical University , 137 South Liyushan Road, Urumqi 830011 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Xu","sequence":"additional","affiliation":[{"name":"Tianjin Chest Hospital, School of Medicine, Tianjin University , Tianjin ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7832-1425","authenticated-orcid":false,"given":"Jingquan","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Qilu Hospital of Shandong University , Jinan , China"},{"name":"Department of Cardiology, Qilu Hospital of Shandong University (Qingdao) , Qingdao ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Li","sequence":"additional","affiliation":[{"name":"The Affiliated Hospital of Guizhou Medical University Department of Cardiovascular Medicine, , Guiyang 550004, Guizhou ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0607-0010","authenticated-orcid":false,"given":"Zhongbao","family":"Ruan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Affiliated Taizhou People's Hospital of Nanjing Medical University , Taizhou ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Lu","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Nantong University Department of Cardiology, , Nantong 226000, Jiangsu ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7704-2522","authenticated-orcid":false,"given":"Suxia","family":"Guo","sequence":"additional","affiliation":[{"name":"The Tenth Affiliated Hospital of Southern Medical University (Dongguan People's Hospital), Southern Medical University , Dongguan 523018 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9292-6884","authenticated-orcid":false,"given":"Jingfeng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou, Guangdong 510120 ,","place":["PRC"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3523-0573","authenticated-orcid":false,"given":"Bing","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Xuzhou Central Hospital , Xuzhou ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University, School of Medicine , Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0482-0738","authenticated-orcid":false,"given":"Tong","family":"Liu","sequence":"additional","affiliation":[{"name":"Tianjin Key Laboratory of Ion and Molecular Function of Cardiovascular Diseases, Department of Cardiology, Second Hospital of Tianjin Medical University, Tianjin Institute of Cardiology , Tianjin ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8164-9183","authenticated-orcid":false,"given":"Rui","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, West China Hospital, Sichuan University , Chengdu ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangui","family":"He","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University , Guangzhou ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Zhi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zhongda Hospital, Southeast University , Nanjing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changjian","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , 197 Ruijin Second Road, Shanghai 200025 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2170-2258","authenticated-orcid":false,"given":"Yue","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , 197 Ruijin Second Road, Shanghai 200025 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