{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:54:09Z","timestamp":1791906849483,"version":"4.3.4"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"17","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2016,4,26]]},"abstract":"<jats:sec>\n                    <jats:title>Background\u2014<\/jats:title>\n                    <jats:p>Whether catheter ablation (CA) is superior to amiodarone (AMIO) for the treatment of persistent atrial fibrillation (AF) in patients with heart failure is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results\u2014<\/jats:title>\n                    <jats:p>\n                      This was an open-label, randomized, parallel-group, multicenter study. Patients with persistent AF, dual-chamber implantable cardioverter defibrillator or cardiac resynchronization therapy defibrillator, New York Heart Association II to III, and left ventricular ejection fraction &lt;40% within the past 6 months were randomly assigned (1:1 ratio) to undergo CA for AF (group 1, n=102) or receive AMIO (group 2, n=101). Recurrence of AF was the primary end point. All-cause mortality and unplanned hospitalization were the secondary end points. Patients were followed up for a minimum of 24 months. At the end of follow-up, 71 (70%; 95% confidence interval, 60%\u201378%) patients in group 1 were recurrence free after an average of 1.4\u00b10.6 procedures in comparison with 34 (34%; 95% confidence interval, 25%\u201344%) in group 2 (log-rank\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). The success rate of CA in the different centers after a single procedure ranged from 29% to 61%. After adjusting for covariates in the multivariable model, AMIO therapy was found to be significantly more likely to fail (hazard ratio, 2.5; 95% confidence interval, 1.5\u20134.3;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001) than CA. Over the 2-year follow-up, the unplanned hospitalization rate was (32 [31%] in group 1 and 58 [57%] in group 2;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001), showing 45% relative risk reduction (relative risk, 0.55; 95% confidence interval, 0.39\u20130.76). A significantly lower mortality was observed in CA (8 [8%] versus AMIO (18 [18%];\n                      <jats:italic>P<\/jats:italic>\n                      =0.037).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>This multicenter randomized study shows that CA of AF is superior to AMIO in achieving freedom from AF at long-term follow-up and reducing unplanned hospitalization and mortality in patients with heart failure and persistent AF.<\/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: NCT00729911.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.115.019406","type":"journal-article","created":{"date-parts":[[2016,4,25]],"date-time":"2016-04-25T17:43:41Z","timestamp":1461606221000},"page":"1637-1644","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":776,"title":["Ablation Versus Amiodarone for Treatment of Persistent Atrial Fibrillation in Patients With Congestive Heart Failure and an Implanted Device"],"prefix":"10.1161","volume":"133","author":[{"given":"Luigi","family":"Di Biase","sequence":"first","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prasant","family":"Mohanty","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanghamitra","family":"Mohanty","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasquale","family":"Santangeli","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chintan","family":"Trivedi","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhanunjaya","family":"Lakkireddy","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madhu","family":"Reddy","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Jais","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakis","family":"Themistoclakis","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Dello Russo","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Casella","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemma","family":"Pelargonio","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Lucia","family":"Narducci","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Schweikert","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petr","family":"Neuzil","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Sanchez","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney","family":"Horton","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); 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Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Hao","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Rossillo","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Forleo","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Tondo","sequence":"additional","affiliation":[{"name":"From Texas Cardiac Arrhythmia Institute at St. David\u2019s Medical Center, Austin (L.D.B., P.M., S.M., P.S., C.T., J.S., R.H., J.D.B., A.N.); Albert Einstein College of Medicine, at Montefiore Hospital, New York, NY (L.D.B.); Department of Biomedical Engineering, University of Texas, Austin (L.D.B., A.N.); Department of Cardiology, University of Foggia, Italy (L.D.B.); University of Kansas, Kansas City (D.L., M.R.); H\u00f4pital Cardiologique du Haut L\u00e9v\u00eaque, Universit\u00e9 Victor-Segalen Bordeaux, France (P.J.,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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