{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:02:31Z","timestamp":1791295351765,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"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"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pulmonary vein isolation (PVI) is the standard ablation strategy for paroxysmal atrial fibrillation (PAF). Despite guideline recommendations favoring PVI alone in PAF, some operators routinely perform extra pulmonary vein ablation (PVI+) during initial procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine frequency of PVI+ strategy for treatment of PAF in the real world and examine its impact on arrhythmic recurrence and progression compared to PVI alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the TriNetX research network, we identified adults with PAF who underwent catheter ablation between January 2020 and January 2024. Recurrence was defined as repeat ablation, cardioversion, or antiarrhythmic drug (AAD) use beyond a 3\u2010month blanking period. Progression to persistent AF and atypical atrial flutter were also assessed. Kaplan\u2010Meier analysis was performed with 3\u2010year follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Before matching, 5134 of 18,891 patients (27.2%) underwent PVI+. In the propensity matched analysis (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20095020 per group), recurrence was significantly higher in the PVI+ group (HR 1.28, 95% CI 1.16\u20131.42;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Repeat ablation, cardioversion and AAD use were more common with PVI+ (HR 1.99, 95% CI 1.60\u20132.46;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001, HR 1.37, 95% CI 1.13\u20131.66;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001, and HR 1.41, 95% CI 1.05\u20131.87;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.020, respectively). Progression to persistent AF was higher with PVI+ (HR 1.37, 95% CI 1.23\u20131.53,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), as was atypical atrial flutter (HR 2.63, 95% CI 1.97\u20133.50;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Extra\u2010pulmonary vein ablation during first\u2010time PAF ablation remains common in real\u2010world practice but is associated with worse outcomes including repeat ablation, cardioversion, AAD use, atrial flutter, and progression to persistent AF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jce.70519","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T13:32:28Z","timestamp":1791293548000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pulmonary Vein Isolation Alone Versus Adjunctive Ablation for Paroxysmal Atrial Fibrillation"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2038-7678","authenticated-orcid":false,"given":"Michel Abou","family":"Khalil","sequence":"first","affiliation":[{"name":"Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3441-0617","authenticated-orcid":false,"given":"Christian M.","family":"Massad","sequence":"additional","affiliation":[{"name":"Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2542-941X","authenticated-orcid":false,"given":"Eli","family":"Tsakiris","sequence":"additional","affiliation":[{"name":"Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Herbst","sequence":"additional","affiliation":[{"name":"Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine New Orleans Louisiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0148-0080","authenticated-orcid":false,"given":"Maximilian","family":"Moersdorf","sequence":"additional","affiliation":[{"name":"Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine New Orleans Louisiana 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