{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T23:39:58Z","timestamp":1787614798532,"version":"build-2736575974"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Catheter ablation has been shown to improve prognosis in patients with heart failure (HF) and atrial fibrillation (AF); however, the optimal ablation strategy remains undefined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>In this multicenter, randomized controlled trial, 300 patients with persistent AF and HF, including both HF with reduced ejection fraction (ejection fraction \u226440%) and HF with preserved ejection fraction (ejection fraction &gt;40%, including mid-range ejection fraction [ejection fraction 41% to 50%]), were enrolled and randomized equally to the anatomic-guided ablation, electrogram-guided ablation, and extensive electrogram-anatomic\u2013guided ablation groups, with 100 patients in each group. The coprimary end points were: (1) the composite of cardiovascular death or HF-related hospitalization\/urgent visit within 36 months; and (2) maintenance of sinus rhythm at 36 months. Secondary end points included AF burden &lt;1%, New York Heart Association class improvement (\u22651 grade), 6-minute walk test change, NT-proBNP (N-terminal pro-B-type natriuretic peptide) reduction, and procedure-related complications. Subgroup analyses were performed for HF with reduced ejection fraction and HF with preserved ejection fraction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      At 36 months, the extensive electro-anatomic\u2013guided ablation group demonstrated the lowest incidence of the composite end point (17.0%) compared with the electrogram-guided ablation (29.0%) and anatomic-guided ablation (36.0%; overall\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.010) groups, and the highest rate of sinus rhythm maintenance (62.0%) compared with the electrogram-guided ablation (53.0%) and anatomic-guided ablation (44.0%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.039) groups. Consistent improvements were observed for AF burden &lt;1%, New York Heart Association class, 6-minute walk test, and NT-proBNP. Major complications were low and similar across all groups. These trends were consistent in both the HF with reduced ejection fraction and HF with preserved ejection fraction subgroups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Electrogram-anatomic ablation provides superior long-term rhythm control, reduces cardiovascular events, and improves symptoms in patients with persistent AF and HF, regardless of ejection fraction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>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: NCT07153718.\n                    <\/jats:p>\n     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X.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0921-4688","authenticated-orcid":true,"given":"Xinhua","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, China (X.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8973-2050","authenticated-orcid":true,"given":"Mu","family":"Qin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Shanghai Jiao Tong University School of Medicine, Shanghai Chest Hospital, China (K.L., M.Q., W.J., Y.Z., S.W., K.X., X.L., X.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4657-4687","authenticated-orcid":true,"given":"Ping","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong 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Shanghai Chest Hospital, China (K.L., M.Q., W.J., Y.Z., S.W., K.X., X.L., X.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4222-2092","authenticated-orcid":true,"given":"Qidong","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Yuhuan Second People\u2019s Hospital, Zhejiang, China (Q.Z., A.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0374-9566","authenticated-orcid":true,"given":"Anjing","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Yuhuan Second People\u2019s Hospital, Zhejiang, China (Q.Z., A.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4195-5702","authenticated-orcid":true,"given":"Menghe","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Second Affiliated Hospital of Shandong University of 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