{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T18:12:54Z","timestamp":1781115174741,"version":"3.54.1"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2016,1]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Various ablation strategies of persistent atrial fibrillation (PersAF) have had disappointing outcomes, despite concerted clinical and research efforts, which could reflect progressive atrial fibrillation\u2013related atrial remodeling.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              Two-year outcomes were assessed in 1241 consecutive patients undergoing first-time ablation of PersAF (2005\u20132012). The time intervals between the first diagnosis of PersAF and the ablation procedures were determined. Patients had echocardiograms and measures of B-type natriuretic peptide and C-reactive protein before the procedures. The median diagnosis-to-ablation time was 3 years (25th\u201375th percentiles 1\u20136.5). With longer diagnosis-to-ablation time (based on quartiles), there was a significant increase in recurrence rates in addition to an increase in B-type natriuretic peptide levels (\n              <jats:italic>P<\/jats:italic>\n              =0.01), C-reactive protein levels (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001), and left atrial size (\n              <jats:italic>P<\/jats:italic>\n              =0.03). The arrhythmia recurrence rates over 2 years were 33.6%, 52.6%, 57.1%, and 54.6% in the first, second, third, and fourth quartiles, respectively (\n              <jats:italic>P<\/jats:italic>\n              <jats:sub>categorical<\/jats:sub>\n              &lt;0.0001). In Cox Proportional Hazard analyses, B-type natriuretic peptide levels, C-reactive protein levels, and left atrial size were associated with arrhythmia recurrence. The diagnosis-to-ablation time had the strongest association with the ablation outcomes which persisted in multivariable Cox analyzes (hazard ratio for recurrence per +1Log diagnosis-to-ablation time 1.27, 95% confidence interval 1.14\u20131.43;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001; hazard ratio fourth versus first quartile 2.44, 95% confidence interval 1.68\u20133.65;\n              <jats:italic>P<\/jats:italic>\n              <jats:sub>categorical<\/jats:sub>\n              &lt;0.0001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>In patients with PersAF undergoing ablation, the time interval between the first diagnosis of PersAF and the catheter ablation procedure had a strong association with the ablation outcomes, such as shorter diagnosis-to-ablation times were associated with better outcomes and in direct association with markers of atrial remodeling.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.115.003669","type":"journal-article","created":{"date-parts":[[2016,1,14]],"date-time":"2016-01-14T11:17:55Z","timestamp":1452770275000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":97,"title":["Radiofrequency Ablation of Persistent Atrial Fibrillation"],"prefix":"10.1161","volume":"9","author":[{"given":"Ayman A.","family":"Hussein","sequence":"first","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walid I.","family":"Saliba","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr","family":"Barakat","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Bassiouny","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Chamsi-Pasha","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasha","family":"Al-Bawardy","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Hakim","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaldoun","family":"Tarakji","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Baranowski","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Cantillon","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Dresing","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Tchou","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David O.","family":"Martin","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niraj","family":"Varma","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandeep","family":"Bhargava","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Callahan","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Niebauer","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Kanj","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina","family":"Chung","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Natale","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce D.","family":"Lindsay","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oussama M.","family":"Wazni","sequence":"additional","affiliation":[{"name":"From the Center for Atrial Fibrillation, Section of Cardiac Pacing and Electrophysiology, Cleveland Clinic Foundation, OH (A.A.H., W.I.S., A.B., M.B., M.C.-P., R.A.-B., A.H., K.T., B.B., D.C., T.D., P.T., D.O.M., N.V., M.B., T.C., M.N., M.K., M.C., B.D.L., O.M.W.); and Texas CardiacArrhythmia Institute, St David\u2019s Medical Center, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2011.12.016"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2010.01.017"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2006.12.073"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2008.09.016"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.04.060"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.114.001943"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.91.5.1588"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.92.7.1954"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2007.00941.x"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eur398"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2006.02.1033"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2009.07.007"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.113.000320"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.03.044"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000090688.49283.67"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0008-6363(02)00258-4"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.96.9.3157"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0008-6363(99)00178-9"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.09.026"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000055314.10801.4f"}],"container-title":["Circulation: Arrhythmia and Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCEP.115.003669","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T23:25:23Z","timestamp":1715556323000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCEP.115.003669"}},"subtitle":["Diagnosis-to-Ablation Time, Markers of Pathways of Atrial Remodeling, and Outcomes"],"short-title":[],"issued":{"date-parts":[[2016,1]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2016,1]]}},"alternative-id":["10.1161\/CIRCEP.115.003669"],"URL":"https:\/\/doi.org\/10.1161\/circep.115.003669","relation":{},"ISSN":["1941-3149","1941-3084"],"issn-type":[{"value":"1941-3149","type":"print"},{"value":"1941-3084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,1]]},"assertion":[{"value":"2015-09-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-11-25","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-01-13","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}