{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T18:12:42Z","timestamp":1793211162121,"version":"4.5.0"},"reference-count":76,"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":[[2026,6,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The coexistence of persistent atrial fibrillation (AF) and heart failure with reduced left ventricular ejection fraction is associated with greater morbidity and death than either condition alone. Catheter ablation improves outcomes in selected patients, yet results in persistent AF remain unsatisfactory. Convergent hybrid ablation may offer more durable rhythm control by integrating epicardial and endocardial techniques to achieve homogeneous, transmural pulmonary vein and posterior wall isolation. However, randomized data comparing ablation strategies in patients with reduced left ventricular ejection fraction are lacking, leaving a critical evidence gap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">HALT AF (Hybrid Ablation for Atrial Fibrillation With Heart Failure) is an investigator\u2010initiated, multicenter, prospective, open\u2010label, randomized controlled trial with blinded outcome assessment. A total of 120 patients with nonparoxysmal AF, left ventricular ejection fraction &lt;50%, and at least moderate left atrial dilatation undergoing first\u2010time ablation will be randomized 1:1 to hybrid ablation or catheter ablation. All patients will receive preablation guideline\u2010directed optimization and undergo strategically equivalent ablation (pulmonary vein isolation plus posterior wall isolation). The primary efficacy end point is freedom from recurrent arrhythmia &gt;30\u2009seconds at 12\u2009months and off class I\/III antiarrhythmic drugs, excluding a 3\u2010month blanking period. The primary safety end point is major adverse cardiovascular events within 30\u2009days. Secondary end points assess cardiac remodeling, biomarkers, symptoms, and quality of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">HALT AF will be the first randomized trial to compare convergent hybrid ablation and catheter ablation in patients with persistent AF and reduced left ventricular function. By enrolling only patients with reduced left ventricular ejection fraction and dilated atria and by equating lesion sets, HALT AF is designed to provide critical evidence to inform rhythm\u2010control strategies and guideline recommendations in this high\u2010risk, underrepresented population.<\/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=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT05411614.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.047774","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T04:33:52Z","timestamp":1780115632000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Convergent Hybrid Ablation Versus Catheter Ablation in Patients With Persistent Atrial Fibrillation and Heart Failure: HALT AF Study Protocol and Rationale for a Multicenter Randomized Controlled Trial"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4416-8986","authenticated-orcid":false,"given":"Omar","family":"Ahmed","sequence":"first","affiliation":[{"name":"City St George\u2019s, University of London","place":["London, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8731-2853","authenticated-orcid":false,"given":"Elijah R.","family":"Behr","sequence":"additional","affiliation":[{"name":"City St George\u2019s, University of London","place":["London, UK"]},{"name":"St George's University Hospitals NHS Foundation Trust","place":["London, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"White","sequence":"additional","affiliation":[{"name":"City St George\u2019s, University of London","place":["London, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aziz","family":"Momin","sequence":"additional","affiliation":[{"name":"St George's University Hospitals NHS Foundation Trust","place":["London, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2812-6049","authenticated-orcid":false,"suffix":"MBChB, FRC","given":"Riyaz A.","family":"Kaba","sequence":"additional","affiliation":[{"name":"City St George\u2019s, University of London","place":["London, UK"]},{"name":"St George's University Hospitals NHS Foundation Trust","place":["London, UK"]},{"name":"Ashford and St Peter's Hospital Foundation Trust","place":["Surrey, UK"]},{"name":"University of London","place":["London, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae176"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001193"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1707855"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2306037"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eux297"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euaf037"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11897-024-00691-9"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.124.012939"},{"key":"e_1_3_2_10_2","first-page":"25","volume-title":"Hybrid Ablation Therapy for Atrial Fibrillation","author":"Ahmed O","year":"2026","unstructured":"Ahmed O, Ho Y, Shilling R. Non\u2010pulmonary vein substrate in atrial fibrillation. In: Momin A, Kaba RA, eds Hybrid Ablation Therapy for Atrial Fibrillation. Edizioni Minerva Medica; 2026:25\u201361."},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.05.061"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.107.754564"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.09.064"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.96.11.4027"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2008.01.016"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.109.910125"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv233"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.120.008512"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehq041"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.113.000890"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1408288"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.8831"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.23722"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.022346"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euy325"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2022.12.011"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2023.102052"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezaf146"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.16195"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.124.013427"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.120.009288"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.120.008461"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.0693"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.15901"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.acvd.2024.10.333"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2333"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad195"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.12.012"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2023.12.024"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.005119"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.028981"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.15420\/aer.2019.20"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.15420\/aer.2022.05"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2025.03.515"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.125.013977"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2020.10.004"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaf1115"},{"key":"e_1_3_2_49_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.16776"},{"key":"e_1_3_2_50_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2502280"},{"key":"e_1_3_2_51_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-012-0322-4"},{"key":"e_1_3_2_52_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCEP.110.958033"},{"key":"e_1_3_2_53_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(92)90986-6"},{"key":"e_1_3_2_54_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezy475"},{"key":"e_1_3_2_55_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1712000"},{"key":"e_1_3_2_56_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/ehaa946.0629"},{"key":"e_1_3_2_57_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euae195"},{"key":"e_1_3_2_58_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.027852"},{"key":"e_1_3_2_59_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-024-01046-6"},{"key":"e_1_3_2_60_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.117.309732"},{"key":"e_1_3_2_61_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10741-020-09978-0"},{"key":"e_1_3_2_62_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(02)01236-6"},{"key":"e_1_3_2_63_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30968-0"},{"key":"e_1_3_2_64_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.111.962688"},{"key":"e_1_3_2_65_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2017.05.001"},{"key":"e_1_3_2_66_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.050991"},{"key":"e_1_3_2_67_2","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.14814"},{"key":"e_1_3_2_68_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euae102.224"},{"key":"e_1_3_2_69_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2018.11.030"},{"key":"e_1_3_2_70_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjae.2023.05.006"},{"key":"e_1_3_2_71_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.xjtc.2021.04.006"},{"key":"e_1_3_2_72_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2020.11.021"},{"key":"e_1_3_2_73_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.3026"},{"key":"e_1_3_2_74_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euae043"},{"key":"e_1_3_2_75_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.056109"},{"key":"e_1_3_2_76_2","doi-asserted-by":"publisher","DOI":"10.1111\/pace.14941"},{"key":"e_1_3_2_77_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.07.039"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.125.047774","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T13:26:52Z","timestamp":1781789212000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.125.047774"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,2]]},"references-count":76,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,6,2]]}},"alternative-id":["10.1161\/JAHA.125.047774"],"URL":"https:\/\/doi.org\/10.1161\/jaha.125.047774","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,2]]},"assertion":[{"value":"2025-12-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e047774"}}