{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T15:38:17Z","timestamp":1791992297007,"version":"4.4.0"},"reference-count":33,"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":[[2025,1]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Pulmonary vein isolation (PVI) alone is less effective in patients with persistent atrial fibrillation (AF) compared with those with paroxysmal AF. We investigate whether additional linear ablation from the superior vena cava to the right atrial septum and cavotricuspid isthmus ablation improves the rhythm outcome of patients with persistent AF undergoing cryoballoon PVI (Cryo-PVI).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>In this investigator-initiated, multicenter, randomized clinical trial, 289 patients with persistent AF refractory to antiarrhythmic drug therapy were randomized 1:1 to either Cryo-PVI with additional right atrium (RA) linear ablation or Cryo-PVI alone. The primary end point was any documented atrial arrhythmia lasting \u226530 seconds after a 3-month blanking period after ablation. The secondary end points were atrial arrhythmia recurrence or antiarrhythmic drug use after a 3-month blanking period, complications, and total procedure time.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              During the median follow-up of 24 months (median age, 63 years; 23.9% women), the atrial arrhythmia recurrence was less frequent in the additional RA ablation group (n=50, 37.5%) than in the Cryo-PVI alone group (n=69, 53.1%; absolute difference, \u221215.6% [95% CI, \u221227.9% to \u22123.4%]; hazard ratio, 0.66 [95% CI, 0.46\u20130.94]). Antiarrhythmic drugs were prescribed after the 3-month period to 72 (49.3%) patients in the additional RA ablation group and 79 (55.2%) patients in the Cryo-PVI alone group. No difference was found in complication rate between the 2 groups. Total procedure time was longer in the additional RA ablation group (median, 88 versus 72 minutes;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Additional RA linear ablation beyond Cryo-PVI improved the ablation outcome compared with that of PVI alone in persistent AF patients.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.124.013408","type":"journal-article","created":{"date-parts":[[2024,12,19]],"date-time":"2024-12-19T10:00:25Z","timestamp":1734602425000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Cryoballoon Pulmonary Vein Isolation With Versus Without Additional Right Atrial Linear Ablation for Persistent Atrial Fibrillation: The CRALAL Randomized Clinical Trial"],"prefix":"10.1161","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9736-450X","authenticated-orcid":true,"given":"Daehoon","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Yonsei University Health System, Seoul, Republic of Korea (D.K., H.T.Y., T.-H.K., J.-S.U., B.J., M.-H.L., H.-N.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6835-4759","authenticated-orcid":true,"given":"Hee Tae","family":"Yu","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Yonsei University Health System, Seoul, Republic of Korea (D.K., H.T.Y., T.-H.K., J.-S.U., B.J., M.-H.L., H.-N.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8251-1522","authenticated-orcid":true,"given":"Jaemin","family":"Shim","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea (J.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junbeom","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ewha Womans University Medical Center, Seoul, Republic of Korea (J.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7126-4861","authenticated-orcid":true,"given":"Yong-Soo","family":"Baek","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine and Inha University Hospital, Incheon, Republic of Korea (Y.-S.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Won","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea (S.W.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dae-Kyeong","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Inje University Busan Paik Hospital, Republic of Korea (D.-K.K., Y.-A.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4711-290X","authenticated-orcid":true,"given":"Young-Ah","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Inje University Busan Paik Hospital, Republic of Korea (D.-K.K., 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