{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T09:19:11Z","timestamp":1791537551264,"version":"4.3.4"},"reference-count":43,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T00:00:00Z","timestamp":1748995200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T00:00:00Z","timestamp":1748995200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Ablation of fibrotic atrial regions has been suggested to improve the results of atrial fibrillation (AF) catheter ablation. We aimed to evaluate the efficacy and safety of fibrosis\u2010guided ablation in addition to pulmonary vein isolation (PVI) among AF patients undergoing ablation through a systematic review of randomized controlled trials. The review protocol was registered on PROSPERO (CRD42024561077). Database searches were conducted on EMBASE and MEDLINE until 6th September 2024. Freedom from atrial arrhythmia (including AF and\/or atrial tachycardia) and periprocedural complications were the main outcomes. Twelve trials (total of 3,066 patients) were included in the analysis. Ten studies utilized three\u2010dimensional electroanatomic voltage mapping, and two used magnetic resonance imaging (MRI) to map atrial fibrosis. Compared to PVI, adjunctive fibrosis\u2010guided ablation significantly improved freedom from atrial arrhythmia (risk ratio [RR] 1.13; 95% confidence interval [CI] 1.04\u2009\u2212\u20091.23;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.004; I\u00b2\u2009=\u200935%). This benefit was seen in persistent AF (RR 1.13; 95% CI 1.01\u2009\u2212\u20091.25;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.03), but not paroxysmal AF (RR 1.16; 95% CI 0.83\u2009\u2212\u20091.61;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.20). Only low\u2010voltage area ablation showed improved freedom from atrial arrhythmias (RR 1.17; 95% CI 1.06\u2009\u2212\u20091.28\n                    <jats:italic>vs<\/jats:italic>\n                    . RR 1.03; 95% CI 0.80\u2009\u2212\u20091.32 using MRI\u2010voltage detection). A numerically, but nonsignificant, higher rate of periprocedural complications was observed with fibrosis\u2010guided ablation (4.4%\n                    <jats:italic>vs<\/jats:italic>\n                    . 2.8%; RR 1.44; 95% CI 0.82\u20132.56;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.18) driven by the results of the DECAAF\u2010II trial. Fibrosis\u2010guided ablation, targeting low\u2010voltage areas on electroanatomic mapping, may be an effective adjunctive target to PVI for improving AF freedom, particularly for persistent AF. However, this approach poses safety concerns.\n                  <\/jats:p>","DOI":"10.1111\/jce.16723","type":"journal-article","created":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T01:25:12Z","timestamp":1749086712000},"page":"2025-2040","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Fibrosis\u2010Guided Ablation in Patients With Atrial Fibrillation: A Meta\u2010Analysis of Randomized Controlled Trials"],"prefix":"10.1111","volume":"36","author":[{"given":"Ahmed","family":"Salih","sequence":"first","affiliation":[{"name":"School of Medicine Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aman","family":"Sutaria","sequence":"additional","affiliation":[{"name":"University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeinab","family":"Montaser","sequence":"additional","affiliation":[{"name":"Nasr City Hospital For Health Insurance Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony Pun","family":"Magar","sequence":"additional","affiliation":[{"name":"Oxford Health NHS Foundation Trust Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gehad","family":"El Ashal","sequence":"additional","affiliation":[{"name":"Ashford and St Peter's Hospitals NHS Foundation Trust Chertsey Surrey UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheref","family":"Zaghloul","sequence":"additional","affiliation":[{"name":"Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust Reading UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1404-0989","authenticated-orcid":false,"given":"Alen Jiji","family":"Tom","sequence":"additional","affiliation":[{"name":"Hillingdon Hospital, Hillingdon Hospitals NHS Foundation Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmood","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Cardiology Royal Free Hospital, Royal Free London NHS Foundation Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Creta","sequence":"additional","affiliation":[{"name":"Institute of Health Informatics Research University College London London UK"},{"name":"Barts Heart Centre, St Bartholomew's Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3469-1028","authenticated-orcid":false,"given":"Hussam","family":"Ali","sequence":"additional","affiliation":[{"name":"Arrhythmia and Clinical Electrophysiology Center IRCCS, MultiMedica Sesto San Giovanni, Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4064-3767","authenticated-orcid":false,"given":"Sergio","family":"Barra","sequence":"additional","affiliation":[{"name":"Department of Cardiology Hospital da Luz Arr\u00e1bida Vila Nova de Gaia Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1673-7712","authenticated-orcid":false,"given":"Michal","family":"Farkowski","sequence":"additional","affiliation":[{"name":"Department of Cardiology Ministry of Interior and Administration National Medical Institute Warsaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0615-9525","authenticated-orcid":false,"given":"Riccardo","family":"Cappato","sequence":"additional","affiliation":[{"name":"Arrhythmia and Clinical Electrophysiology Center IRCCS, MultiMedica Sesto San Giovanni, Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Providencia","sequence":"additional","affiliation":[{"name":"Institute of Health Informatics Research University College London London UK"},{"name":"Barts Heart Centre, St Bartholomew's Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,4]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(73)90527-8"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1994.03510350050036"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4482"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2024.03.017"},{"key":"e_1_2_9_6_1","first-page":"1","article-title":"2024 ESC Guidelines for the Management of Atrial Fibrillation Developed in Collaboration With the European Association for Cardio\u2010Thoracic Surgery (EACTS)","volume":"1","author":"Van Gelder I. 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