{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T06:16:06Z","timestamp":1789971366623,"version":"4.0.1"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Catheter ablation for persistent atrial fibrillation (AF) is associated with less favorable outcomes than for paroxysmal AF. Substrate modification is often added to pulmonary vein isolation (PVI) to try to improve success rates. Recent studies have shown improved clinical outcomes with use of regional ablation index (AI) targets for PVI. We hypothesized that prospective use of AI-guided PVI in persistent AF patients would result in a low rate of PV reconnection at repeat electrophysiology study and that a high success rate can be achieved with durable PVI alone.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Forty consecutive patients with persistent AF underwent AI-guided PVI with target values of 550 for anterior and 400 for posterior left atrial regions, followed by a protocol-mandated repeat procedure after 2 months. Patients were monitored for atrial tachyarrhythmia recurrence via daily plus symptom-initiated ECG recordings for 12 months. Recurrence was defined as \u226530 seconds of any atrial tachyarrhythmia after a 3-month blanking period.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>PV reconnection was seen at repeat electrophysiology study in 22% of patients, affecting 7% of PVs. Ablation on the intervenous carina was required in 44% patients to achieve durable PVI. Atrial tachyarrhythmia recurrence was documented in 8 (20%) patients, only one of whom had PV reconnection at repeat study. At 12 months, 38\/40 (95%) patients were in sinus rhythm, with 4 (10%) patients having started antiarrhythmic drugs. Higher body mass index and excess alcohol consumption were the only significant factors associated with atrial tachyarrhythmia recurrence.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Use of AI targets results in a high level of durable PVI. A good clinical outcome can be achieved in the great majority of persistent AF patients with AI-guided PVI alone.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration<\/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=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT02628730.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.118.006576","type":"journal-article","created":{"date-parts":[[2018,9,16]],"date-time":"2018-09-16T05:40:48Z","timestamp":1537076448000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":283,"title":["Use of Ablation Index-Guided Ablation Results in High Rates of Durable Pulmonary Vein Isolation and Freedom From Arrhythmia in Persistent Atrial Fibrillation Patients"],"prefix":"10.1161","volume":"11","author":[{"given":"Ahmed","family":"Hussein","sequence":"first","affiliation":[{"name":"Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moloy","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom (M.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Riva","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, Milan, Italy (S.R., A.D.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Morgan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Ronayne","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ankita","family":"Sahni","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Shaw","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derick","family":"Todd","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Modi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Natale","sequence":"additional","affiliation":[{"name":"St David\u2019s Medical Centre, Austin, TX (A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Dello Russo","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino, Milan, Italy (S.R., A.D.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Snowdon","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhiraj","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, England, United Kingdom (A.H., M.M., C.R., A.S., M.S., D.T., M.H., S.M., R.S., D.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.115.003337"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv139"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1408288"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euv057"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euw105"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.128.suppl_22.A12104"},{"key":"e_1_3_4_8_2","first-page":"S114. 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