{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T14:45:12Z","timestamp":1792421112110,"version":"4.5.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"17","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,9,5]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">An optimal strategy for left atrial ablation in addition to pulmonary vein isolation (PVI) in patients with persistent atrial fibrillation (AF) has not been determined.<\/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              We conducted an extended follow\u2010up of the multicenter randomized controlled EARNEST\u2010PVI (Efficacy of Pulmonary Vein Isolation Alone in Patients With Persistent Atrial Fibrillation) trial, which compared 12\u2010month rhythm outcomes in patients with persistent AF between patients randomized to a PVI\u2010alone strategy (n=248) or PVI\u2010plus strategy (n=248; PVI followed by left atrial additional ablation, including linear ablation or ablation targeting areas with complex fractionated electrograms). The present study extended the follow\u2010up period to 3\u2009years after enrollment. Outcomes were compared not only between randomly allocated groups but also between on\u2010treatment groups categorized by actually created ablation lesions. Recurrence rate of AF or atrial tachycardia (AT) was lower in the randomly allocated to PVI\u2010plus group than the PVI\u2010alone group (29.0% versus 37.5%,\n              <jats:italic>P<\/jats:italic>\n              =0.036). On\u2010treatment analysis revealed that patients with PVI+linear ablation (n=205) demonstrated a lower AF\/AT recurrence rate than those with PVI only (26.3% versus 37.8%,\n              <jats:italic>P<\/jats:italic>\n              =0.007). In contrast, patients with PVI+complex fractionated electrograms ablation (n=37) had an AF\/AT recurrence rate comparable to that of patients with PVI only (40.5% versus 37.8%,\n              <jats:italic>P<\/jats:italic>\n              =0.76). At second ablation in 126 patients with AF\/AT recurrence, ATs excluding common atrial flutter were more frequent in patients with PVI+linear ablation than in those with PVI only (32.6% versus 5.7%,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Left atrial ablation in addition to PVI was efficacious during 3\u2010year follow\u2010up. Linear ablation was superior to other ablation strategies but may increase iatrogenic ATs.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.umin.ac.jp\/ctr\/index-j.htm\">http:\/\/www.umin.ac.jp\/ctr\/index\u2010j.htm<\/jats:ext-link>\n              ; Unique identifier: UMIN000019449.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.029651","type":"journal-article","created":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T09:34:55Z","timestamp":1693301695000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":29,"title":["Long\u2010Term Impact of Additional Ablation After Pulmonary Vein Isolation: Results From EARNEST\u2010PVI Trial"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5566-466X","authenticated-orcid":false,"given":"Masaharu","family":"Masuda","sequence":"first","affiliation":[{"name":"Cardiovascular Center Kansai Rosai Hospital Amagasaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8389-549X","authenticated-orcid":false,"given":"Koichi","family":"Inoue","sequence":"additional","affiliation":[{"name":"Cardiovascular Division National Hospital Organization Osaka National Hospital Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuaki","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Cardiovascular Center Sakurabashi Watanabe Hospital Osaka 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