{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T20:45:07Z","timestamp":1771533907971,"version":"3.50.1"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,1,8]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The objective was to explore the efficacy of ablation lesion sets in addition to pulmonary vein isolation (\n              <jats:styled-content style=\"fixed-case\">PVI<\/jats:styled-content>\n              ) for paroxysmal atrial fibrillation. The optimal strategy for catheter ablation of paroxysmal atrial fibrillation is debated.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The SMASH\u2010AF (Systematic Review and Meta\u2010analysis of Ablation Strategy Heterogeneity in Atrial Fibrillation) study cohort includes trials and observational studies identified in PubMed, Scopus, and Cochrane databases from January 1 1990, to August 1, 2016. We included studies reporting single procedure paroxysmal atrial fibrillation ablation success rates. Exclusion criteria included insufficient reporting of outcomes, ablation strategies that were not prespecified and uniform, and a sample size of fewer than 40 patients. We analyzed lesion sets performed in addition to\n              <jats:styled-content style=\"fixed-case\">PVI<\/jats:styled-content>\n              (\n              <jats:styled-content style=\"fixed-case\">PVI<\/jats:styled-content>\n              plus) using multivariable random\u2010effects meta\u2010regression to control for patient, study, and procedure characteristics. The analysis included 145 total studies with 23\u00a0263 patients (\n              <jats:styled-content style=\"fixed-case\">PVI\u2010<\/jats:styled-content>\n              only cohort: 115 studies, 148 treatment arms, 16\u00a0500 patients;\n              <jats:styled-content style=\"fixed-case\">PVI<\/jats:styled-content>\n              plus cohort: 39 studies; 46 treatment arms, 6763 patients).\n              <jats:styled-content style=\"fixed-case\">PVI<\/jats:styled-content>\n              plus studies, as compared with\n              <jats:styled-content style=\"fixed-case\">PVI<\/jats:styled-content>\n              \u2010only studies, included younger patients (56.7\u00a0years versus 58.8\u00a0years,\n              <jats:italic>P<\/jats:italic>\n              =0.001), fewer women (27.2% versus 32.0% women,\n              <jats:italic>P<\/jats:italic>\n              =0.002), and were more methodologically rigorous with longer follow\u2010up (29.5 versus 17.1\u00a0months,\n              <jats:italic>P<\/jats:italic>\n              0.004) and more randomization (19.4% versus 11.8%,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). In multivariable meta\u2010regression,\n              <jats:styled-content style=\"fixed-case\">PVI<\/jats:styled-content>\n              plus studies were associated with improved success (7.6% absolute improvement [95% CI, 2.6\u201312.5%];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.01,\n              <jats:italic>I<\/jats:italic>\n              <jats:sup>2<\/jats:sup>\n              =88%), specifically superior vena cava isolation (4 studies, 4 treatment arms, 1392 patients; 15.1% absolute improvement [95%\u00a0CI, 2.3\u201327.9%];\n              <jats:italic>P<\/jats:italic>\n              0.02,\n              <jats:italic>I<\/jats:italic>\n              <jats:sup>2<\/jats:sup>\n              =87%). However, residual heterogeneity was large.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Across the paroxysmal atrial fibrillation ablation literature,\n              <jats:styled-content style=\"fixed-case\">PVI<\/jats:styled-content>\n              plus ablation strategies were associated with incremental improvements in success rate. However, large residual heterogeneity complicates evidence synthesis.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.118.009976","type":"journal-article","created":{"date-parts":[[2018,12,27]],"date-time":"2018-12-27T10:00:19Z","timestamp":1545904819000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Efficacy of Ablation Lesion Sets in Addition to Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation: Findings From the SMASH\u2010AF Meta\u2010Analysis Study Cohort"],"prefix":"10.1161","volume":"8","author":[{"given":"Andrew","family":"Cluckey","sequence":"first","affiliation":[{"name":"Department of Medicine Stanford University School of Medicine Stanford CA"},{"name":"Veterans Affairs Palo Alto Health Care System Palo Alto CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander C.","family":"Perino","sequence":"additional","affiliation":[{"name":"Department of Medicine Stanford University School of Medicine Stanford CA"},{"name":"Veterans Affairs Palo Alto Health Care System Palo Alto CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fahd N.","family":"Yunus","sequence":"additional","affiliation":[{"name":"Department of Medicine Stanford University School of Medicine Stanford CA"},{"name":"Veterans Affairs Palo Alto Health Care System Palo Alto CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George C.","family":"Leef","sequence":"additional","affiliation":[{"name":"Department of Medicine Stanford University School of Medicine Stanford CA"},{"name":"Veterans Affairs Palo Alto Health Care System Palo Alto CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariam","family":"Askari","sequence":"additional","affiliation":[{"name":"Veterans Affairs Palo Alto Health Care System Palo Alto CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul A.","family":"Heidenreich","sequence":"additional","affiliation":[{"name":"Department of Medicine Stanford University School of Medicine Stanford CA"},{"name":"Veterans Affairs Palo Alto Health Care System Palo Alto CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjiv M.","family":"Narayan","sequence":"additional","affiliation":[{"name":"Department of Medicine Stanford University School of Medicine Stanford CA"},{"name":"Veterans Affairs Palo Alto Health Care System Palo Alto CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul J.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medicine Stanford University School of Medicine Stanford CA"},{"name":"Veterans Affairs Palo Alto Health Care System Palo Alto CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mintu P.","family":"Turakhia","sequence":"additional","affiliation":[{"name":"Department of Medicine Stanford University School of Medicine Stanford CA"},{"name":"Veterans Affairs Palo Alto Health Care System Palo Alto CA"},{"name":"Center for Digital Health Stanford University School of Medicine Stanford CA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199809033391003"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/415219a"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10840-012-9723-0"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2015.07.008"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2011.02.033"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.02.076"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euq384"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.110.958405"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2011.02010.x"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.115.003019"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0164989"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10840-016-0198-2"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.08.083"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/pace.12841"},{"key":"e_1_3_2_16_2","unstructured":"Turakhia M Perino AC. 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