{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:57:54Z","timestamp":1790470674630,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2022,4,5]],"date-time":"2022-04-05T00:00:00Z","timestamp":1649116800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The optimal strategy after a failed ablation for persistent atrial fibrillation (perAF) is unknown. This study evaluated the value of an anatomically guided strategy using a systematic set of linear lesions with adjunctive ethanol infusion into the vein of Marshall (Et\u2010VOM) in patients referred for second perAF ablation procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results<\/jats:title><jats:p>Patients with perAF who underwent a second procedure were grouped according to the two strategies. The first strategy was an anatomically guided approach using systematic linear ablation with adjunctive Et\u2010VOM, with bidirectional blocks at the posterior mitral isthmus (MI), roof, and cavotricuspid isthmus (CTI) as the procedural endpoint (Group I). The second one was an electrophysiology\u2010guided strategy, with atrial tachyarrhythmia termination as the procedural endpoint (Group II). Arrhythmia behavior during the procedure guided the ablation strategy. Groups I and II consisted of 96 patients (65\u2009\u00b1\u20099 years; 71 men) and 102 patients (63\u2009\u00b1\u200910 years; 83 men), respectively. Baseline characteristics were comparable. In Group I, Et\u2010VOM was successfully performed in 91\/96 (95%), and procedural endpoint (bidirectional block across all three anatomical lines) was achieved in 89\/96 (93%). In Group II, procedural endpoint (atrial tachyarrhythmia termination) was achieved in 80\/102 (78%). One\u2010year follow\u2010up demonstrated Group I (21\/96 [22%]) experienced less recurrence compared to Group II (38\/102 [37%], Log\u2010rank <jats:italic>p<\/jats:italic>\u2009=\u2009.01). This was driven by lower AT recurrence in Group I (Group I: 10\/96 [10%] vs. Group II: 29\/102 [28%]; <jats:italic>p<\/jats:italic>\u2009=\u2009.002).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Anatomically guided strategy with adjunctive Et\u2010VOM is superior to an electrophysiology\u2010guided strategy for second procedures in patients with perAF at 1\u2010year follow\u2010up.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.15472","type":"journal-article","created":{"date-parts":[[2022,3,29]],"date-time":"2022-03-29T03:34:28Z","timestamp":1648524868000},"page":"1116-1124","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Strategy for repeat procedures in patients with persistent atrial fibrillation: Systematic linear ablation with adjunctive ethanol infusion into the vein of Marshall versus electrophysiology\u2010guided ablation"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8538-9259","authenticated-orcid":false,"given":"Takashi","family":"Nakashima","sequence":"first","affiliation":[{"name":"CHU Bordeaux, IHU Lyric Universit\u00e9 de Bordeaux Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6763-2350","authenticated-orcid":false,"given":"Thomas","family":"Pambrun","sequence":"additional","affiliation":[{"name":"CHU Bordeaux, IHU Lyric Universit\u00e9 de Bordeaux Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Vlachos","sequence":"additional","affiliation":[{"name":"CHU Bordeaux, IHU Lyric Universit\u00e9 de Bordeaux Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyril","family":"Goujeau","sequence":"additional","affiliation":[{"name":"CHU Bordeaux, IHU Lyric Universit\u00e9 de Bordeaux Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cl\u00e9mentine","family":"Andr\u00e9","sequence":"additional","affiliation":[{"name":"CHU Bordeaux, IHU Lyric Universit\u00e9 de Bordeaux Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Krisai","sequence":"additional","affiliation":[{"name":"CHU Bordeaux, IHU Lyric Universit\u00e9 de Bordeaux Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4350-1652","authenticated-orcid":false,"given":"F. 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