{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T04:29:43Z","timestamp":1782275383195,"version":"3.54.5"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">We evaluated long\u2010term outcome of isolation of pulmonary veins, left atrial posterior wall, and superior vena cava, including time to recurrence and prevalent triggering foci at repeat ablation in patients with paroxysmal atrial fibrillation with or without cardiovascular comorbidities.<\/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              A total of 1633 consecutive patients with paroxysmal atrial fibrillation that were arrhythmia\u2010free for 2 years following the index ablation were classified into: group 1 (without comorbidities); n=692 and group 2 (with comorbidities); n=941. We excluded patients with documented ablation of areas other than pulmonary veins, the left atrial posterior wall, and the superior vena cava at the index procedure. At 10\u00a0years after an average of 1.2 procedures, 215 (31%) and 480 (51%) patients had recurrence with median time to recurrence being 7.4 (interquartile interval [IQI] 4.3\u20138.5) and 5.6 (IQI 3.8\u20138.3) years in group 1 and 2, respectively. A total of 201 (93.5%) and 456 (95%) patients from group 1 and 2 underwent redo ablation; 147\/201 and 414\/456 received left atrial appendage and coronary sinus isolation and 54\/201 and 42\/456 had left atrial lines and flutter ablation. At 2\u00a0years after the redo, 134 (91.1%) and 391 (94.4%) patients from group 1 and 2 receiving left atrial appendage\/coronary sinus isolation remained arrhythmia\u2010free whereas sinus rhythm was maintained in 4 (7.4%) and 3 (7.1%) patients in respective groups undergoing empirical lines and flutter ablation (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Very late recurrence of atrial fibrillation after successful isolation of pulmonary veins, regardless of the comorbidity profile, was majorly driven by non\u2010pulmonary vein triggers and ablation of these foci resulted in high success rate. However, presence of comorbidities was associated with significantly earlier recurrence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.020563","type":"journal-article","created":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T09:44:18Z","timestamp":1621244658000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":26,"title":["Natural History of Arrhythmia After Successful Isolation of Pulmonary Veins, Left Atrial Posterior Wall, and Superior Vena Cava in Patients With Paroxysmal Atrial Fibrillation: A Multi\u2010Center Experience"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6601-944X","authenticated-orcid":false,"given":"Sanghamitra","family":"Mohanty","sequence":"first","affiliation":[{"name":"Department of Electrophysiology Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chintan","family":"Trivedi","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1239-648X","authenticated-orcid":false,"given":"Pamela","family":"Horton","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology St. Edward's University Austin TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico G.","family":"Della Rocca","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8174-7207","authenticated-orcid":false,"given":"Carola","family":"Gianni","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3819-8273","authenticated-orcid":false,"given":"Bryan","family":"MacDonald","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1973-8254","authenticated-orcid":false,"given":"Angel","family":"Mayedo","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. Joseph","family":"Gallinghouse","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8547-025X","authenticated-orcid":false,"given":"Amin","family":"Al\u2010Ahmad","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney P.","family":"Horton","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. David","family":"Burkhardt","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology Texas Cardiac Arrhythmia InstituteSt. David's Medical Center Austin TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Dello Russo","sequence":"additional","affiliation":[{"name":"Clinica di Cardiologia ed Aritmologia Ospedali Reuniti Ancona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Casella","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology RCCS Monzino Hospital Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8500-8313","authenticated-orcid":false,"given":"Claudio","family":"Tondo","sequence":"additional","affiliation":[{"name":"Department of Electrophysiology RCCS Monzino Hospital Milan 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