{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:19:44Z","timestamp":1787008784465,"version":"build-2736575974"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2019,5,9]],"date-time":"2019-05-09T00:00:00Z","timestamp":1557360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute of Health Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100014461","name":"Biomedical Research Centre","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100014461","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"name":"ElectroCardioMaths Programme of the Imperial Centre for Cardiac Engineering"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Ablation of persistent atrial fibrillation (PsAF) has been performed by many techniques with varying success rates. This may be due to ablation techniques, patient demographics, comorbidities, and trial design. We conducted a meta-regression of studies of PsAF ablation to elucidate the factors affecting atrial fibrillation (AF) recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results\u2003<\/jats:title>\n                    <jats:p>Databases were searched for prospective studies of PsAF ablation. A meta-regression was performed. Fifty-eight studies (6767 patients) were included. Complex fractionated atrial electrogram (CFAE) ablation reduced freedom from AF by 8.9% [95% confidence interval (CI) \u221215 to \u22122.3, P\u2009=\u20090.009). Left atrial appendage [LAA isolation (three study arms)] increased freedom from AF by 39.5% (95% CI 9.1\u201378.4, P\u2009=\u20090.008). Posterior wall isolation (PWI) (eight study arms) increased freedom from AF by 19.4% (95% CI 3.3\u201338.1, P\u2009=\u20090.017). Linear ablation or ganglionated plexi ablation resulted in no significant effect on freedom from AF. More extensive ablation increased intraprocedural AF termination; however, intraprocedural AF termination was not associated with improved outcomes. Increased left atrial diameter was associated with a reduction in freedom from AF by 4% (95% CI \u22126.8% to \u22121.1%, P\u2009=\u20090.007) for every 1\u2009mm increase in diameter.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion\u2003<\/jats:title>\n                    <jats:p>Linear ablation, PWI, and CFAE ablation improves intraprocedural AF termination, but such termination does not predict better long-term outcomes. Study arms including PWI or LAA isolation in the lesion set were associated with improved outcomes in terms of freedom from AF; however, further randomized trials are required before these can be routinely recommended. Left atrial size is the most important marker of AF chronicity influencing outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euz108","type":"journal-article","created":{"date-parts":[[2019,3,28]],"date-time":"2019-03-28T00:27:48Z","timestamp":1553732868000},"page":"1176-1184","source":"Crossref","is-referenced-by-count":30,"title":["Optimum lesion set and predictors of outcome in persistent atrial fibrillation ablation: a meta-regression analysis"],"prefix":"10.1093","volume":"21","author":[{"given":"Arunashis","family":"Sau","sequence":"first","affiliation":[{"name":"International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayed","family":"Al-Aidarous","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Howard","sequence":"additional","affiliation":[{"name":"International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK"},{"name":"Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Shalhoub","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afzal","family":"Sohaib","sequence":"additional","affiliation":[{"name":"International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Shun-Shin","sequence":"additional","affiliation":[{"name":"International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK"},{"name":"Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul G","family":"Novak","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Jubilee Hospital, Victoria, 1952 Bay St, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rick","family":"Leather","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Jubilee Hospital, Victoria, 1952 Bay St, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence D","family":"Sterns","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Jubilee Hospital, Victoria, 1952 Bay St, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Lane","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Jubilee Hospital, Victoria, 1952 Bay St, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prapa","family":"Kanagaratnam","sequence":"additional","affiliation":[{"name":"International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK"},{"name":"Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas S","family":"Peters","sequence":"additional","affiliation":[{"name":"International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK"},{"name":"Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darrel P","family":"Francis","sequence":"additional","affiliation":[{"name":"International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK"},{"name":"Department of Cardiology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus B","family":"Sikkel","sequence":"additional","affiliation":[{"name":"International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK"},{"name":"Department of Cardiology, Royal Jubilee Hospital, Victoria, 1952 Bay St, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,5,9]]},"reference":[{"key":"2019121022403846600_euz108-B1","doi-asserted-by":"crossref","first-page":"199","DOI":"10.2174\/1573403X13666170117125124","article-title":"The short and long-term efficacy of pulmonary vein isolation as a sole treatment strategy for paroxysmal atrial fibrillation: a systematic review and meta-analysis","volume":"13","author":"Kis","year":"2017","journal-title":"Curr Cardiol Rev"},{"key":"2019121022403846600_euz108-B2","first-page":"CD012088","article-title":"Efficacy and safety of ablation for people with non-paroxysmal atrial fibrillation. 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Meta-analysis of 1415 patients","volume":"8","author":"Providencia","year":"2015","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2019121022403846600_euz108-B10","first-page":"528.","article-title":"Outcomes of persistent and long-standing persistent atrial fibrillation ablation: a systematic review and meta-analysis","volume":"14","author":"Clarnette","year":"2017","journal-title":"Europace"},{"key":"2019121022403846600_euz108-B11","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1161\/CIRCEP.114.001759","article-title":"Efficacy of catheter ablation for persistent atrial fibrillation: a systematic review and meta-analysis of evidence from randomized","volume":"7","author":"Wynn","year":"2014","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2019121022403846600_euz108-B12","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1161\/CIRCEP.109.924878","article-title":"Circumferential pulmonary vein ablation with additional linear ablation results in an increased incidence of left atrial flutter compared with segmental pulmonary vein isolation as an initial approach to ablation of paroxysmal atrial fibrillation","volume":"3","author":"Sawhney","year":"2010","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2019121022403846600_euz108-B13","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1016\/S0003-4975(96)01282-9","article-title":"Efficacy of a simple left atrial procedure for chronic atrial fibrillation in mitral valve operations","volume":"63","author":"Sueda","year":"1997","journal-title":"Ann Thorac Surg"},{"key":"2019121022403846600_euz108-B14","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1161\/CIRCEP.111.970293","article-title":"Single-ring posterior left atrial (box) isolation results in a different mode of recurrence compared with wide antral pulmonary vein isolation on long-term follow-up: longer atrial fibrillation-free survival time but similar survival time free of any atrial","volume":"5","author":"Lim","year":"2012","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2019121022403846600_euz108-B15","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.ijcard.2014.12.035","article-title":"Does isolation of the left atrial posterior wall improve clinical outcomes after radiofrequency catheter ablation for persistent atrial fibrillation?","volume":"181","author":"Kim","year":"2015","journal-title":"Int J Cardiol"},{"key":"2019121022403846600_euz108-B16","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1161\/CIRCEP.108.797944","article-title":"Left atrial posterior wall isolation does not improve the outcome of circumferential pulmonary vein ablation for atrial fibrillation","volume":"2","author":"Tamborero","year":"2009","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2019121022403846600_euz108-B17","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1161\/CIRCULATIONAHA.109.928903","article-title":"Left atrial appendage: an underrecognized trigger site of atrial fibrillation","volume":"122","author":"Di Biase","year":"2010","journal-title":"Circulation"},{"key":"2019121022403846600_euz108-B18","doi-asserted-by":"crossref","first-page":"e003710","DOI":"10.1161\/CIRCEP.115.003710","article-title":"Left atrial appendage electrical isolation and concomitant device occlusion to treat persistent atrial fibrillation: a first-in-human safety, feasibility, and efficacy study","volume":"9","author":"Panikker","year":"2016","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2019121022403846600_euz108-B19","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1111\/jce.12655","article-title":"Sequential percutaneous LAA ligation and pulmonary vein isolation in patients with persistent AF: initial results of a feasibility study","volume":"26","author":"Badhwar","year":"2015","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2019121022403846600_euz108-B20","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1161\/CIRCEP.114.001721","article-title":"Is ablation to termination the best strategy for ablation of persistent atrial fibrillation? Persistent atrial fibrillation is best ablated by a strategy that terminates the arrhythmia procedural termination is associated with improved long-term outcomes","volume":"8","author":"Lim","year":"2015","journal-title":"Circ Arrhythm Electrophysiol"}],"container-title":["EP Europace"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/europace\/article-pdf\/21\/8\/1176\/29094331\/euz108.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/europace\/article-pdf\/21\/8\/1176\/29094331\/euz108.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T10:32:46Z","timestamp":1663151566000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/europace\/article\/21\/8\/1176\/5487276"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5,9]]},"references-count":20,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2019,5,9]]},"published-print":{"date-parts":[[2019,8,1]]}},"URL":"https:\/\/doi.org\/10.1093\/europace\/euz108","relation":{},"ISSN":["1099-5129","1532-2092"],"issn-type":[{"value":"1099-5129","type":"print"},{"value":"1532-2092","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,8]]},"published":{"date-parts":[[2019,5,9]]}}}