{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T15:18:16Z","timestamp":1791299896516,"version":"4.1.0"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2012,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background\u2014<\/jats:title>\n                    <jats:p>The single-procedure efficacy of pulmonary vein isolation (PVI) is less than optimal in patients with persistent atrial fibrillation (AF). Adjunctive techniques have been developed to enhance single-procedure efficacy in these patients. We conducted a study to compare 3 ablation strategies in patients with persistent AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results\u2014<\/jats:title>\n                    <jats:p>\n                      Subjects were randomized as follows: arm 1, PVI + ablation of non-PV triggers identified using a stimulation protocol (standard approach); arm 2, standard approach + empirical ablation at common non-PV AF trigger sites (mitral annulus, fossa ovalis, eustachian ridge, crista terminalis, and superior vena cava); or arm 3, standard approach + ablation of left atrial complex fractionated electrogram sites. Patients were seen at 6 weeks, 6 months, and 1 year; transtelephonic monitoring was performed at each visit. Antiarrhythmic drugs were discontinued at 3 to 6 months. The primary study end point was freedom from atrial arrhythmias off antiarrhythmic drugs at 1 year after a single-ablation procedure. A total of 156 patients (aged 59\u00b19 years; 136 males; AF duration, 47\u00b150 months) participated (arm 1, 55 patients; arm 2, 50 patients; arm 3, 51 patients). Procedural outcomes (procedure, fluoroscopy, and PVI times) were comparable between the 3 arms. More lesions were required to target non-PV trigger sites than a complex fractionated electrogram (33\u00b19 versus 22\u00b19;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). The primary end point was achieved in 71 patients and was worse in arm 3 (29%) compared with arm 1 (49%;\n                      <jats:italic>P<\/jats:italic>\n                      =0.04) and arm 2 (58%;\n                      <jats:italic>P<\/jats:italic>\n                      =0.004).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>These data suggest that additional substrate modification beyond PVI does not improve single-procedure efficacy in patients with persistent AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration\u2014<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\">http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      . Unique identifier: NCT00379301.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circep.111.966226","type":"journal-article","created":{"date-parts":[[2011,12,3]],"date-time":"2011-12-03T15:25:38Z","timestamp":1322925938000},"page":"287-294","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":243,"title":["Randomized Ablation Strategies for the Treatment of Persistent Atrial Fibrillation"],"prefix":"10.1161","volume":"5","author":[{"given":"Sanjay","family":"Dixit","sequence":"first","affiliation":[{"name":"From the Cardiovascular Division (S.D., F.E.M., D.L., D.J.C., R.B., M.P.R., F.C.G., M.D.H., J.M.C., R.J.V., V.V.P., E.S.Z., N.R.C., T.K., T.T.T., E.P.G.), Hospital of the University of Pennsylvania, and the Center for Clinical Epidemiology and Biostatistics (S.J.R.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis E.","family":"Marchlinski","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division (S.D., F.E.M., D.L., D.J.C., R.B., M.P.R., F.C.G., M.D.H., J.M.C., R.J.V., V.V.P., E.S.Z., N.R.C., T.K., T.T.T., E.P.G.), Hospital of the University of Pennsylvania, and the Center for Clinical Epidemiology and Biostatistics (S.J.R.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Lin","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division (S.D., F.E.M., D.L., D.J.C., R.B., M.P.R., F.C.G., M.D.H., J.M.C., R.J.V., V.V.P., E.S.Z., N.R.C., T.K., T.T.T., E.P.G.), Hospital of the University of Pennsylvania, and the Center for Clinical Epidemiology and Biostatistics (S.J.R.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Callans","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division (S.D., F.E.M., D.L., D.J.C., R.B., M.P.R., F.C.G., M.D.H., J.M.C., R.J.V., V.V.P., E.S.Z., N.R.C., T.K., T.T.T., E.P.G.), Hospital of the University of Pennsylvania, and the Center for Clinical Epidemiology and Biostatistics (S.J.R.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupa","family":"Bala","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division (S.D., F.E.M., D.L., D.J.C., R.B., M.P.R., F.C.G., M.D.H., J.M.C., R.J.V., V.V.P., E.S.Z., N.R.C., T.K., T.T.T., E.P.G.), Hospital of the University of Pennsylvania, and the Center for Clinical Epidemiology and Biostatistics (S.J.R.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Riley","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division (S.D., F.E.M., D.L., D.J.C., R.B., M.P.R., F.C.G., M.D.H., J.M.C., R.J.V., V.V.P., E.S.Z., N.R.C., T.K., T.T.T., E.P.G.), Hospital of the University of Pennsylvania, and the Center for Clinical Epidemiology and Biostatistics (S.J.R.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fermin C.","family":"Garcia","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division (S.D., F.E.M., D.L., D.J.C., R.B., M.P.R., F.C.G., M.D.H., J.M.C., R.J.V., V.V.P., E.S.Z., N.R.C., T.K., T.T.T., E.P.G.), Hospital of the University of Pennsylvania, and the Center for Clinical Epidemiology and Biostatistics (S.J.R.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathew D.","family":"Hutchinson","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division (S.D., F.E.M., D.L., D.J.C., R.B., M.P.R., F.C.G., M.D.H., J.M.C., R.J.V., V.V.P., E.S.Z., N.R.C., T.K., T.T.T., E.P.G.), Hospital of the University of Pennsylvania, and the Center for Clinical Epidemiology and Biostatistics (S.J.R.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah J.","family":"Ratcliffe","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division (S.D., F.E.M., D.L., D.J.C., R.B., M.P.R., F.C.G., M.D.H., J.M.C., R.J.V., V.V.P., E.S.Z., N.R.C., T.K., T.T.T., E.P.G.), Hospital of the University of Pennsylvania, and the Center for Clinical Epidemiology and Biostatistics (S.J.R.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua M.","family":"Cooper","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division (S.D., F.E.M., D.L., D.J.C., R.B., M.P.R., F.C.G., M.D.H., J.M.C., R.J.V., V.V.P., E.S.Z., N.R.C., T.K., T.T.T., E.P.G.), Hospital of the University of Pennsylvania, and the Center for Clinical Epidemiology and Biostatistics (S.J.R.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph J.","family":"Verdino","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division (S.D., F.E.M., D.L., D.J.C., R.B., M.P.R., F.C.G., M.D.H., J.M.C., R.J.V., V.V.P., E.S.Z., N.R.C., T.K., T.T.T., E.P.G.), Hospital of the University of Pennsylvania, and the Center for Clinical Epidemiology and Biostatistics (S.J.R.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vickas V.","family":"Patel","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division (S.D., F.E.M., D.L., D.J.C., R.B., M.P.R., F.C.G., M.D.H., J.M.C., R.J.V., V.V.P., E.S.Z., N.R.C., T.K., T.T.T., E.P.G.), Hospital of the University of Pennsylvania, and the Center for Clinical Epidemiology and Biostatistics (S.J.R.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica S.","family":"Zado","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division (S.D., F.E.M., D.L., D.J.C., R.B., M.P.R., F.C.G., M.D.H., J.M.C., R.J.V., V.V.P., E.S.Z., N.R.C., T.K., T.T.T., E.P.G.), Hospital of the University of Pennsylvania, and the Center for Clinical Epidemiology and Biostatistics (S.J.R.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy R.","family":"Cash","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division (S.D., F.E.M., D.L., D.J.C., R.B., M.P.R., F.C.G., M.D.H., J.M.C., R.J.V., V.V.P., E.S.Z., N.R.C., T.K., T.T.T., E.P.G.), Hospital of the University of Pennsylvania, and the Center for Clinical Epidemiology and Biostatistics (S.J.R.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tony","family":"Killian","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division (S.D., F.E.M., D.L., D.J.C., R.B., M.P.R., F.C.G., M.D.H., J.M.C., R.J.V., V.V.P., E.S.Z., N.R.C., T.K., T.T.T., E.P.G.), Hospital of the University of Pennsylvania, and the Center for Clinical Epidemiology and Biostatistics (S.J.R.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd T.","family":"Tomson","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division (S.D., F.E.M., D.L., D.J.C., R.B., M.P.R., F.C.G., M.D.H., J.M.C., R.J.V., V.V.P., E.S.Z., N.R.C., T.K., T.T.T., E.P.G.), Hospital of the University of Pennsylvania, and the Center for Clinical Epidemiology and Biostatistics (S.J.R.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward P.","family":"Gerstenfeld","sequence":"additional","affiliation":[{"name":"From the Cardiovascular Division (S.D., F.E.M., D.L., D.J.C., R.B., M.P.R., F.C.G., M.D.H., J.M.C., R.J.V., V.V.P., E.S.Z., N.R.C., T.K., T.T.T., E.P.G.), Hospital of the University of Pennsylvania, and the Center for Clinical Epidemiology and Biostatistics (S.J.R.), University of Pennsylvania, Philadelphia, 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