{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:54:41Z","timestamp":1787018081116,"version":"build-2736575974"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"25","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2024,12,17]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Ablation strategies for patients with symptomatic atrial fibrillation and isolated pulmonary veins vary and their effects on arrhythmia recurrence remain unclear. A prospective randomized German multicenter trial sought to compare 2 ablation strategies in this patient cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Patients with atrial fibrillation despite durable pulmonary vein isolation were randomly assigned at 7 centers to undergo low-voltage area ablation using 3-dimensional mapping and irrigated radiofrequency current ablation (group A) or empirical left atrial appendage isolation (LAAI) using the cryoballoon followed by staged interventional left atrial appendage closure (group B). The primary end point was freedom from atrial tachyarrhythmias between 91 and 365 days after index ablation. The study was powered for superiority of LAAI compared with low-voltage area.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Patients (40% women; mean age, 68.8\u00b18 years) with paroxysmal (32%) or persistent atrial fibrillation (68%) were randomized to undergo low-voltage area ablation (n=79) or cryoballoon-guided LAAI (n=82). After a planned interim analysis, enrollment was halted for futility on January 10, 2023. In the LAAI group, 77 of 82 left atrial appendages were successfully isolated with subsequent left atrial appendage closure in 57 patients. Procedure-related complications occurred in 4 (5%) and 11 (13.5%) patients in group A and B, respectively (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.10). The median follow-up was 367 days (interquartile range, 359\u2013378). The Kaplan-Meier point estimate for freedom from atrial tachyarrhythmias was 51.7% (CI, 40.9%\u201365.4%) for group A and 55.5% (CI, 44.4%\u201369.2%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.8069) for group B.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>The current study did not detect superiority of cryoballoon-guided LAAI over low-voltage area ablation in patients with atrial fibrillation despite durable PVI.<\/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: NCT04056390.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.124.069993","type":"journal-article","created":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T05:00:56Z","timestamp":1728277256000},"page":"2007-2018","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Ablation Strategies for Repeat Procedures in Atrial Fibrillation Recurrences Despite Durable Pulmonary Vein Isolation: The Prospective Randomized ASTRO AF Multicenter Trial"],"prefix":"10.1161","volume":"150","clinical-trial-number":[{"clinical-trial-number":"nct04056390","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5347-9906","authenticated-orcid":true,"given":"Boris","family":"Schmidt","sequence":"first","affiliation":[{"name":"Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (B.S., S.B., D. Schaack, K.-R.J.C.)."},{"name":"Universit\u00e4tsklinikum Frankfurt, Medizinische Klinik 3\u2013Klinik f\u00fcr Kardiologie, Frankfurt, Germany (B.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0282-4658","authenticated-orcid":true,"given":"Stefano","family":"Bordignon","sequence":"additional","affiliation":[{"name":"Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (B.S., S.B., D. Schaack, K.-R.J.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Metzner","sequence":"additional","affiliation":[{"name":"University Heart and Vascular Center Hamburg (UHZ), Germany (A.M., A.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3037-8704","authenticated-orcid":true,"given":"Philipp","family":"Sommer","sequence":"additional","affiliation":[{"name":"Clinic for Electrophysiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universit\u00e4t Bochum, Bad Oeynhausen, Germany (P.S., C.S., T.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6839-5895","authenticated-orcid":true,"given":"Daniel","family":"Steven","sequence":"additional","affiliation":[{"name":"University Hospital Cologne\u2013Heart Center, Germany (D. Steven, A.S., J.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6211-7162","authenticated-orcid":true,"given":"Tilmann","family":"Dahme","sequence":"additional","affiliation":[{"name":"Uniklinik Ulm, Klinik f\u00fcr Innere Medizin II, Ulm, Germany (T.D., K.W.-E., A.P.)."},{"name":"Klinikum Esslingen, Klinik f\u00fcr Kardiologie, Angiologie und Pneumologie, Esslingen, Germany (T.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5559-7030","authenticated-orcid":true,"given":"Matthias","family":"Busch","sequence":"additional","affiliation":[{"name":"Universitaetsmedizin Greifswald, Germany (M.B., A.H.)."},{"name":"Helios Hanseklinikum Stralsund, Klinik f\u00fcr Innere Medizin und Kardiologie, Stralsund, Germany (M.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0122-7130","authenticated-orcid":true,"given":"Roland Richard","family":"Tilz","sequence":"additional","affiliation":[{"name":"Schleswig-Holstein University Clinic, L\u00fcbeck Campus, Germany (R.R.T., J.V., C.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4188-3447","authenticated-orcid":true,"given":"David","family":"Schaack","sequence":"additional","affiliation":[{"name":"Cardioangiologisches Centrum Bethanien, Frankfurt, Germany (B.S., S.B., D. 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