{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T22:29:10Z","timestamp":1790116150831,"version":"4.0.1"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Pulmonary vein isolation (PVI) for persistent atrial fibrillation is associated with limited success rates and often requires multiple procedures to maintain stable sinus rhythm. In the prospective and randomized Alster-Lost-AF trial (Ablation at St. Georg Hospital for Long-Standing Persistent Atrial Fibrillation), we sought to assess, in patients with symptomatic persistent or long-standing persistent atrial fibrillation, the outcomes of initial ablative strategies comprising either stand-alone PVI (PVI-only approach) or a stepwise approach of PVI followed by complex fractionated atrial electrogram ablation and linear ablation (Substrate-modification approach).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              Patients were randomized 1:1 to stand-alone PVI or PVI plus substrate modification. The primary study end point was freedom from recurrence of any atrial tachyarrhythmia, outside a 90-day blanking period, at 12 months. A total of 124 patients were enrolled, with 118 patients included in the analysis (61 in the PVI-only group, 57 in the Substrate-modification group). Atrial tachyarrhythmias recurred in 28 PVI-only group patients and 24 Substrate-modification group patients, for 1-year freedom from tachyarrhythmia recurrence after a single ablation procedure of 54% (95% confidence interval, 43%\u201368%) in the PVI-only and 57% (95% confidence interval, 46%\u201372%) in the Substrate-modification group (\n              <jats:italic>P<\/jats:italic>\n              =0.86). Twenty-four patients in the PVI-only group (39%) and 18 in the Substrate-modification group (32%) were without arrhythmia recurrence and off antiarrhythmic drug therapy at the end of the 12-month follow-up.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>In patients with persistent and long-standing persistent atrial fibrillation, no significant difference was observed in 12-month freedom from atrial tachyarrhythmias between an index ablative approach of stand-alone PVI and a stepwise approach of PVI plus complex fractionated atrial electrogram and linear 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: NCT00820625.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.117.005114","type":"journal-article","created":{"date-parts":[[2017,7,8]],"date-time":"2017-07-08T01:10:40Z","timestamp":1499476240000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":161,"title":["Stand-Alone Pulmonary Vein Isolation Versus Pulmonary Vein Isolation With Additional Substrate Modification as Index Ablation Procedures in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation"],"prefix":"10.1161","volume":"10","author":[{"given":"Thomas","family":"Fink","sequence":"first","affiliation":[{"name":"From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (T.F., C.-H.H., C.L., T.M., B.R., J.R., L.R., F.S., B.S., S.M., C.S., F.O., A.M., K.-H.K.); and Asklepios Proresearch, Hamburg, Germany (M.S., P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Schl\u00fcter","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (T.F., C.-H.H., C.L., T.M., B.R., J.R., L.R., F.S., B.S., S.M., C.S., F.O., A.M., K.-H.K.); and Asklepios Proresearch, Hamburg, Germany (M.S., P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian-Hendrik","family":"Heeger","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (T.F., C.-H.H., C.L., T.M., B.R., J.R., L.R., F.S., B.S., S.M., C.S., F.O., A.M., K.-H.K.); and Asklepios Proresearch, Hamburg, Germany (M.S., P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Lemes","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (T.F., C.-H.H., C.L., T.M., B.R., J.R., L.R., F.S., B.S., S.M., C.S., F.O., A.M., K.-H.K.); and Asklepios Proresearch, Hamburg, Germany (M.S., P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tilman","family":"Maurer","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (T.F., C.-H.H., C.L., T.M., B.R., J.R., L.R., F.S., B.S., S.M., C.S., F.O., A.M., K.-H.K.); and Asklepios Proresearch, Hamburg, Germany (M.S., P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Reissmann","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (T.F., C.-H.H., C.L., T.M., B.R., J.R., L.R., F.S., B.S., S.M., C.S., F.O., A.M., K.-H.K.); and Asklepios Proresearch, Hamburg, Germany (M.S., P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Riedl","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (T.F., C.-H.H., C.L., T.M., B.R., J.R., L.R., F.S., B.S., S.M., C.S., F.O., A.M., K.-H.K.); and Asklepios Proresearch, Hamburg, Germany (M.S., P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Rottner","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (T.F., C.-H.H., C.L., T.M., B.R., J.R., L.R., F.S., B.S., S.M., C.S., F.O., A.M., K.-H.K.); and Asklepios Proresearch, Hamburg, Germany (M.S., P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Santoro","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (T.F., C.-H.H., C.L., T.M., B.R., J.R., L.R., F.S., B.S., S.M., C.S., F.O., A.M., K.-H.K.); and Asklepios Proresearch, Hamburg, Germany (M.S., P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris","family":"Schmidt","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (T.F., C.-H.H., C.L., T.M., B.R., J.R., L.R., F.S., B.S., S.M., C.S., F.O., A.M., K.-H.K.); and Asklepios Proresearch, Hamburg, Germany (M.S., P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Wohlmuth","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (T.F., C.-H.H., C.L., T.M., B.R., J.R., L.R., F.S., B.S., S.M., C.S., F.O., A.M., K.-H.K.); and Asklepios Proresearch, Hamburg, Germany (M.S., P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shibu","family":"Mathew","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (T.F., C.-H.H., C.L., T.M., B.R., J.R., L.R., F.S., B.S., S.M., C.S., F.O., A.M., K.-H.K.); and Asklepios Proresearch, Hamburg, Germany (M.S., P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Sohns","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (T.F., C.-H.H., C.L., T.M., B.R., J.R., L.R., F.S., B.S., S.M., C.S., F.O., A.M., K.-H.K.); and Asklepios Proresearch, Hamburg, Germany (M.S., P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feifan","family":"Ouyang","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (T.F., C.-H.H., C.L., T.M., B.R., J.R., L.R., F.S., B.S., S.M., C.S., F.O., A.M., K.-H.K.); and Asklepios Proresearch, Hamburg, Germany (M.S., P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Metzner","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (T.F., C.-H.H., C.L., T.M., B.R., J.R., L.R., F.S., B.S., S.M., C.S., F.O., A.M., K.-H.K.); and Asklepios Proresearch, Hamburg, Germany (M.S., P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl-Heinz","family":"Kuck","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany (T.F., C.-H.H., C.L., T.M., B.R., J.R., L.R., F.S., B.S., S.M., C.S., F.O., A.M., K.-H.K.); and Asklepios Proresearch, Hamburg, Germany (M.S., P.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.946806"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2011.12.016"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.04.060"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.10.054"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2008.01393.x"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.108.774885"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2005.50192.x"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2008.09.016"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.111.966226"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehq041"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.09.088"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehl093"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1408288"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2003.12.054"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2005.00308.x"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.114.001943"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.114.001672"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2006.09.115"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.115.003337"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2011.04.012"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2012.02370.x"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.01.081"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.113.000374"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euv057"}],"container-title":["Circulation: Arrhythmia and Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCEP.117.005114","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T08:09:14Z","timestamp":1738829354000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCEP.117.005114"}},"subtitle":["The Randomized Alster-Lost-AF Trial (Ablation at St. Georg Hospital for Long-Standing Persistent Atrial Fibrillation)"],"short-title":[],"issued":{"date-parts":[[2017,7]]},"references-count":24,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2017,7]]}},"alternative-id":["10.1161\/CIRCEP.117.005114"],"URL":"https:\/\/doi.org\/10.1161\/circep.117.005114","relation":{},"ISSN":["1941-3149","1941-3084"],"issn-type":[{"value":"1941-3149","type":"print"},{"value":"1941-3084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,7]]},"assertion":[{"value":"2017-02-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-06-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-07-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e005114"}}