{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:10:18Z","timestamp":1787015418743,"version":"build-2736575974"},"reference-count":38,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"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":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Robotic\u2010enhanced hybrid ablation (RE\u2010HA) is a promising strategy for persistent (PsAF) and long\u2010standing persistent atrial fibrillation (LS\u2010PsAF). The impact of post\u2010epicardial conduction gaps and atrial fibrosis on early arrhythmia recurrence (EAR) is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess whether conduction gaps and atrial fibrosis predict EAR within 3 months after the epicardial stage of RE\u2010HA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Forty\u2010two PsAF\/LS\u2010PsAF patients underwent RE\u2010HA with left atrial appendage closure. High\u2010density endocardial mapping at 3 months identified fixed (present in all maps) and functional (present in \u22651 but not all maps) conduction gaps. Atrial fibrosis was quantified by pre\u2010procedural cardiac magnetic resonance (CMR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Gaps were found in 18 patients (42.3%): functional in 10 (23.8%) and fixed in 13 (31.0%), with 5 (12%) showing both. EAR occurred in 12 patients (28.6%), AFL in 10\/12 (83.3%). Gaps predicted AFL (OR 4.56;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003) and EAR (OR 3.50;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005). Left atrium LGE\u2009\u2265\u200910% independently predicted EAR (OR 7.50;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.019) with no interaction with gap presence (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.24). Total RF time was similar between groups despite more gaps in recurrence cases, reflecting procedural factors beyond gap count. Roof\u2010line gaps predominated and colocalized with epicardial fat on CMR.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Delayed high\u2010density mapping after RE\u2010HA reveals fixed and functional conduction gaps, especially at the roof line, that\u2014together with pre\u2010ablation fibrosis\u2014independently predict EAR. These findings highlight distinct anatomical and electrophysiological risk domains and support substrate assessment with targeted endocardial completion in a staged workflow.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jce.70117","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T08:30:48Z","timestamp":1759134648000},"page":"3173-3183","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Functional Gaps and Atrial Fibrosis as Predictors of Early Arrhythmia Recurrence After Robotic\u2010Enhanced Hybrid Ablation for Persistent Atrial Fibrillation"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4170-9396","authenticated-orcid":false,"given":"Eduardo","family":"Celentano","sequence":"first","affiliation":[{"name":"Department of Electrophysiology Humanitas Gavazzeni Bergamo Italy"},{"name":"Unit Translational Electrophysiology, Department of Cardiology Erasmus University Medical Center Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1185-4178","authenticated-orcid":false,"given":"Ernesto","family":"Cristiano","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Humanitas Gavazzeni Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Bertella","sequence":"additional","affiliation":[{"name":"Department of Cardiac Imaging Humanitas Gavazzeni Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Parrinello","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Humanitas Gavazzeni Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Albano","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Humanitas Gavazzeni Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Ignatiuk","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Humanitas Gavazzeni Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Renda","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Humanitas Gavazzeni Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Bia","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Humanitas Gavazzeni Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthea","family":"d'Amico","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Humanitas Gavazzeni Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"Rainone","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Humanitas Gavazzeni Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ascanio","family":"Graniero","sequence":"additional","affiliation":[{"name":"Department of Minimally Invasive and Robotic Cardiac Surgery Humanitas Gavazzeni Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Giroletti","sequence":"additional","affiliation":[{"name":"Department of Minimally Invasive and Robotic Cardiac Surgery Humanitas Gavazzeni Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Polini","sequence":"additional","affiliation":[{"name":"Department of Management Information and Production Engineering of the University of Bergamo Dalmine Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Gasparri","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery Medical College of Wisconsin Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Schena","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery Medical College of Wisconsin Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Agnino","sequence":"additional","affiliation":[{"name":"Department of Minimally Invasive and Robotic Cardiac Surgery Humanitas Gavazzeni Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0259-6691","authenticated-orcid":false,"given":"Natasja M. S.","family":"De Groot","sequence":"additional","affiliation":[{"name":"Unit Translational Electrophysiology, Department of Cardiology Erasmus University Medical Center Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/physiologia3010004"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11936-023-01011-5"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.23722"},{"key":"e_1_2_11_5_1","article-title":"Identifying Extra Pulmonary Vein Targets for Persistent Atrial Fibrillation Ablation: Bridging Advanced and Conventional Mapping Techniques","volume":"27","author":"Sharp A. J.","year":"2025","journal-title":"Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, And Cardiac Cellular Electrophysiology of the European Society of Cardiology"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.15420\/aer.2022.05"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.21037\/acs-2023-afm-0120"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euae043"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/icvts\/ivaf082"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13061563"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hroo.2024.11.023"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xjtc.2024.02.013"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2019.12.046"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezt115"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2017.05.018"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.crvasa.2017.04.002"},{"key":"e_1_2_11_17_1","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.121.021889","article-title":"Epicardial and Endocardial Ablation Based on Channel Mapping in Patients With Ventricular Tachycardia and Chronic Chagasic Cardiomyopathy: Importance of Late Potential Mapping During Sinus Rhythm to Recognize the Critical Substrate","volume":"11","author":"Dietrich C. D. O.","year":"2022","journal-title":"Journal of the American Heart Association"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2024.04.063"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2024.09.017"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eur428"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae176"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euw219"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12968-018-0514-3"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2022.07.026"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2017.08.001"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2016.02.007"},{"key":"e_1_2_11_27_1","first-page":"38","article-title":"Effectiveness and Safety of Simultaneous Hybrid Thoracoscopic and Endocardial Catheter Ablation of Lone Atrial Fibrillation","volume":"3","author":"Pison L.","year":"2014","journal-title":"Annals of Cardiothoracic Surgery"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.92.9.2565"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.RES.58.3.356"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2020.11.008"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.116.004462"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.16543"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euad194"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10840-025-02035-6"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2019.00135"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10840-011-9594-9"},{"issue":"12","key":"e_1_2_11_37_1","article-title":"Assessing Left Atrial Intramyocardial Fat Infiltration From Computerized Tomography Angiography in Patients With Atrial Fibrillation","volume":"25","author":"Saglietto A.","year":"2023","journal-title":"Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology: Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8191.2007.00454.x"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euaf038"}],"container-title":["Journal of Cardiovascular Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jce.70117","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jce.70117","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jce.70117","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T10:21:25Z","timestamp":1772965285000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jce.70117"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,29]]},"references-count":38,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1111\/jce.70117"],"URL":"https:\/\/doi.org\/10.1111\/jce.70117","archive":["Portico"],"relation":{},"ISSN":["1045-3873","1540-8167"],"issn-type":[{"value":"1045-3873","type":"print"},{"value":"1540-8167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,29]]},"assertion":[{"value":"2025-07-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}