{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T13:59:25Z","timestamp":1768312765386,"version":"3.49.0"},"reference-count":24,"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":[[2016,2]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Achieving long-term successful outcomes with ablation of persistent atrial fibrillation (AF) remains a clinical and procedural challenge. We aimed to assess 2 ablation strategies for persistent AF: pulmonary vein antral isolation (PVAI) in sinus rhythm after direct current cardioversion versus PVAI and ablation targeting complex-fractionated atrial electrograms while in AF.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              Between June 2009 and July 2013, patients with continuous persistent AF for \u22653 months were prospectively randomized to either direct current cardioversion before PVAI and posterior wall\/septum ablation while in sinus rhythm (group 1), versus same ablation in group 1 in addition to complex-fractionated atrial electrogram ablation while in AF (group 2). The procedural profiles and clinical outcomes of the 2 strategies were compared. Ninety patients were randomized to group 1 (n=46) or group 2 (n=44). There were no differences in baseline characteristics between groups. Over 365 days of follow-up after the index procedure, 16 patients (35%) in group 1 and 13 patients (30%) in group 2 remained arrhythmia-free off antiarrhythmic medications. Over long-term follow-up (median, 867 days), arrhythmia-free survival off antiarrhythmic medications was more likely in group 1 than in group 2 in Kaplan\u2013Meier analysis (Log Rank\n              <jats:italic>P<\/jats:italic>\n              =0.04). Group 1 ablation was associated with significantly shorter procedural duration and fluoroscopy time (231\u00b172 versus 273\u00b176 min;\n              <jats:italic>P<\/jats:italic>\n              =0.008 and 54 [Q1\u2013Q3: 46\u201367] versus 66 (Q1\u2013Q3: 53\u201383] min;\n              <jats:italic>P<\/jats:italic>\n              =0.018, respectively).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>In patients with persistent AF, PVAI in sinus rhythm after direct current cardioversion is associated with higher success and shorter procedural and fluoroscopy times compared with PVAI in AF with additional complex-fractionated atrial electrogram ablation.<\/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: NCT02429648.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.115.003596","type":"journal-article","created":{"date-parts":[[2016,2,9]],"date-time":"2016-02-09T01:40:47Z","timestamp":1454982047000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":45,"title":["Randomized Study of Persistent Atrial Fibrillation Ablation"],"prefix":"10.1161","volume":"9","author":[{"given":"Mohamed","family":"Bassiouny","sequence":"first","affiliation":[{"name":"From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Walid","family":"Saliba","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayman","family":"Hussein","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Rickard","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariam","family":"Diab","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wahaj","family":"Aman","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Dresing","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"IV","given":"Thomas","family":"Callahan,","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mandeep","family":"Bhargava","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David O.","family":"Martin","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingyuan","family":"Shao","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan","family":"Baranowski","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khaldoun","family":"Tarakji","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick J.","family":"Tchou","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Hakim","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed","family":"Kanj","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce","family":"Lindsay","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oussama","family":"Wazni","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, 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Arrhythmia and Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCEP.115.003596","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T00:16:41Z","timestamp":1715559401000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCEP.115.003596"}},"subtitle":["Ablate in Sinus Rhythm Versus Ablate Complex-Fractionated Atrial Electrograms in Atrial Fibrillation"],"short-title":[],"issued":{"date-parts":[[2016,2]]},"references-count":24,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2016,2]]}},"alternative-id":["10.1161\/CIRCEP.115.003596"],"URL":"https:\/\/doi.org\/10.1161\/circep.115.003596","relation":{},"ISSN":["1941-3149","1941-3084"],"issn-type":[{"value":"1941-3149","type":"print"},{"value":"1941-3084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,2]]},"assertion":[{"value":"2015-09-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-01-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-02-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}