{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T07:33:05Z","timestamp":1781163185918,"version":"3.54.1"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,3,1]],"date-time":"2018-03-01T00:00:00Z","timestamp":1519862400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Management of persistent atrial fibrillation (PersAF) remains challenging, and many patients are left on medical therapy after a failed first ablation. In patients with recurrent symptomatic arrhythmias after PersAF ablation, we aimed to compare outcomes of repeat ablation and medical therapy versus medical therapy alone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>All 682 consecutive patients with recurrent symptomatic arrhythmia after a first ablation for PersAF at our institution (2005\u20132012) were included. Repeat ablation with continuation of medical therapy was performed in 364 patients (Group 1) and 318 were only medically managed (Group 2). The outcome of interest was freedom from arrhythmia recurrence beyond a 3\u2010month blanking period. Separate analyses were performed to assess this endpoint totally off antiarrhythmics (primary endpoint) or alternatively with\/without use of antiarrhythmics (secondary endpoint). Over a median follow\u2010up of 26 months, 41.5% of Group 1 patients met the primary endpoint and remained free from arrhythmia recurrence off antiarrhythmics (vs. 14.5% in Group 2, P\u00a0&lt;\u00a00.0001). At last follow\u2010up, antiarrhythmics continued to be required for rhythm control in 40.1% and 46.2% of patients in Groups 1 and 2, respectively (P\u00a0&lt;\u00a00.0001). The secondary endpoint was met in 60.2%\u00a0versus 32.1% of patients in Groups 1 and 2, respectively (P\u00a0&lt;\u00a00.0001). In multivariable Cox analyses, repeat ablation was associated with significant reduction in arrhythmia recurrences compared to medical therapy alone (HR 0.48, 95% CI 0.35\u20130.65, P\u00a0&lt;\u00a00.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In patients with recurrent symptomatic arrhythmia after ablation of PersAF, repeat ablation was associated with significant reduction in arrhythmia recurrences compared to routine medical therapy alone.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.13434","type":"journal-article","created":{"date-parts":[[2018,1,25]],"date-time":"2018-01-25T11:39:04Z","timestamp":1516880344000},"page":"551-558","source":"Crossref","is-referenced-by-count":19,"title":["Repeat ablation or medical management alone for recurrent arrhythmias after ablation of persistent atrial fibrillation"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6859-4616","authenticated-orcid":false,"given":"Amr F.","family":"Barakat","sequence":"first","affiliation":[{"name":"Department of Medicine Cleveland Clinic Foundation  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oussama M.","family":"Wazni","sequence":"additional","affiliation":[{"name":"Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute Cleveland Clinic Foundation  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walid I.","family":"Saliba","sequence":"additional","affiliation":[{"name":"Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute Cleveland Clinic Foundation  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edlira","family":"Yzeiraj","sequence":"additional","affiliation":[{"name":"Department of Medicine Cleveland Clinic Foundation  Cleveland OH 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Vascular Institute Cleveland Clinic Foundation  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Callahan","sequence":"additional","affiliation":[{"name":"Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute Cleveland Clinic Foundation  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Cantillon","sequence":"additional","affiliation":[{"name":"Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute Cleveland Clinic Foundation  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Kanj","sequence":"additional","affiliation":[{"name":"Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute Cleveland Clinic Foundation  Cleveland OH 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