{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T08:47:35Z","timestamp":1771490855435,"version":"3.50.1"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T00:00:00Z","timestamp":1707696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The mechanisms of AF development and progression are still not completely understood. Despite the relative efficacy of ablation, the risk of AF recurrence is substantial, particularly in patients with persistent AF (perAF). At present we do not have any reliable intra-procedural electrophysiologic predictors of long-term success of AF ablation other than pulmonary vein isolation. We evaluated selected intraprocedural pulmonary vein characteristics that may be helpful in future guidance of persistent AF ablation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>390 consecutive procedures using cryoballoon for initial AF ablation were divided by clinical presentation (paroxysmal or persistent AF), and by pulmonary vein (PV) response to pacing after completion of ablation (discrete electrogram elicited with pacing\u2014\u201cPV capture\u201d or not\u2014\u201cControl\u201d). Patients were followed (median 20 months) for recurrent atrial arrhythmias as the primary end point of the study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>PV capture was identified in 20.3% and 17.1% and patients with paroxysmal and persistent AF respectively (ns). In patients with persistent AF presence of PV capture was associated with significantly better outcomes compared to patients without PV capture (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). In the group \u201cpersistent AF and PV capture\u201d, an initial strategy of PV isolation and reisolation of the PVs (without additional lesions) for patients with recurrent atrial arrhythmias resulted in 20\/23 (87%) patients in sinus rhythm off antiarrhythmic medications at study completion. In patients with paroxysmal AF, PV capture was not associated with outcome benefits. Speci\ufb01c electrophysiologic characteristics of PV (PV capture cycle length: PVCCL) did not have an impact on AF recurrence, although 25% shortening of PVCCL was observed after 60\u2005s periods of pacing at short cycle lengths. No background demographic patient characteristic differences were identi\ufb01ed between patients with vs. without PV capture.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The presence of PV capture was associated with better outcomes in patients with persistent AF. PV capture may identify those patients with persistent AF in whom cryoballoon PV isolation alone is sufficient as an initial ablation procedure and as the primary ablation strategy for recurrent AF.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2023.1150378","type":"journal-article","created":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T04:40:55Z","timestamp":1707712855000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Pulmonary vein capture is a predictor for long-term success of stand-alone pulmonary vein isolation with cryoballoon ablation in patients with persistent atrial fibrillation"],"prefix":"10.3389","volume":"10","author":[{"given":"Alexey","family":"Babak","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine Bienvenue","family":"Kauffman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cynthia","family":"Lynady","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reginald","family":"McClellan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kalpathi","family":"Venkatachalam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fred","family":"Kusumoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,2,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e275","DOI":"10.1016\/j.hrthm.2017.05.012","article-title":"2017 HRS\/EHRA\/ECAS\/APHRS\/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation","volume":"14","author":"Calkins","year":"2017","journal-title":"Heart Rhythm"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1001\/jama.2019.0693","article-title":"Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial","volume":"321","author":"Packer","year":"2019","journal-title":"JAMA"},{"key":"B3","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1056\/NEJMoa1707855","article-title":"Catheter ablation for atrial fibrillation with heart failure","volume":"378","author":"Marrouche","year":"2018","journal-title":"N Engl J Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1812","DOI":"10.1056\/NEJMoa1408288","article-title":"Approaches to catheter ablation for persistent atrial fibrillation","volume":"372","author":"Verma","year":"2015","journal-title":"N Engl J Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2743","DOI":"10.1016\/j.jacc.2015.09.088","article-title":"Pulmonary vein isolation versus defragmentation: the CHASE-AF clinical trial","volume":"66","author":"Vogler","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1841","DOI":"10.1016\/j.hrthm.2020.06.020","article-title":"Cryoballoon ablation of pulmonary veins for persistent atrial fibrillation: results from the multicenter STOP persistent AF trial","volume":"17","author":"Su","year":"2020","journal-title":"Heart Rhythm"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1440","DOI":"10.1016\/j.jacep.2018.07.007","article-title":"Single-Procedure outcomes and quality-of-life improvement 12 months post-cryoballoon ablation in persistent atrial fibrillation: results from the multicenter CRYO4PERSISTENT AF trial","volume":"4","author":"Boveda","year":"2018","journal-title":"JACC Clin Electrophysiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1093\/europace\/euz313","article-title":"Cryoablation for persistent and longstanding persistent atrial fibrillation: results from a multicentre European registry","volume":"22","author":"Sawhney","year":"2020","journal-title":"Europace"},{"key":"B9","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1093\/europace\/eus353","article-title":"Lessons from dissociated pulmonary vein potentials: entry block implies exit block","volume":"15","author":"Duytschaever","year":"2013","journal-title":"Europace"},{"key":"B10","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1093\/europace\/eut366","article-title":"Real-time assessment of pulmonary vein disconnection during cryoablation of atrial fibrillation: can it be \u2018achieved\u2019 in almost all cases?","volume":"16","author":"Boveda","year":"2014","journal-title":"Europace"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2128","DOI":"10.1016\/j.hrthm.2016.08.018","article-title":"Adenosine testing during cryoballoon ablation and radiofrequency ablation of atrial fibrillation: a propensity score-matched analysis","volume":"13","author":"Tokuda","year":"2016","journal-title":"Heart Rhythm"},{"key":"B12","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1016\/j.hrthm.2020.01.017","article-title":"Prevalence and clinical impact of spontaneous and adenosine-induced pulmonary vein reconduction in the contact-force vs. Cryoballoon atrial fibrillation ablation (CIRCA-DOSE) study","volume":"17","author":"Andrade","year":"2020","journal-title":"Heart Rhythm"},{"key":"B13","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1136\/hrt.2010.211367","article-title":"Dissociated pulmonary vein potentials following antral pulmonary vein isolation for atrial fibrillation: impact on long-term outcome","volume":"97","author":"Lee","year":"2011","journal-title":"Heart"},{"key":"B14","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1111\/jce.12585","article-title":"Loss of local capture of the pulmonary vein myocardium after antral isolation: prevalence and clinical significance","volume":"26","author":"Lee","year":"2015","journal-title":"J Cardiovasc Electrophysiol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"2572","DOI":"10.1111\/jce.14664","article-title":"Lesion characteristics between cryoballoon ablation and radiofrequency ablation with a contact force-sensing catheter: late-gadolinium enhancement magnetic resonance imaging assessment","volume":"31","author":"Kurose","year":"2020","journal-title":"J Cardiovasc Electrophysiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1016\/j.hroo.2022.09.016","article-title":"Driver characteristics associated with structurally and electrically remodeled atria in persistent atrial fibrillation","volume":"3","author":"Dhillon","year":"2022","journal-title":"Heart Rhythm O2"},{"key":"B17","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1111\/jce.15371","article-title":"Location and coupling interval of an ectopic excitation determine the initiation of atrial fibrillation from the pulmonary veins","volume":"33","author":"Kawai","year":"2022","journal-title":"J Cardiovasc Electrophysiol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"2281","DOI":"10.1016\/j.jacc.2004.01.051","article-title":"Electrophysiologic properties of pulmonary veins assessed using a multielectrode basket catheter","volume":"43","author":"Kumagai","year":"2004","journal-title":"J Am Coll Cardiol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1378","DOI":"10.1111\/j.1540-8167.1998.tb00114.x","article-title":"Atrial electrophysiologic remodeling: another vicious circle?","volume":"9","author":"Allessie","year":"1998","journal-title":"J Cardiovasc Electrophysiol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1016\/j.jacep.2019.06.002","article-title":"Dynamic atrial substrate during high-density mapping of paroxysmal and persistent AF: implications for substrate ablation","volume":"5","author":"Wong","year":"2019","journal-title":"JACC Clin Electrophysiol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1016\/j.hrthm.2011.09.010","article-title":"High-density epicardial mapping of the pulmonary vein-left atrial junction in humans: insights into mechanisms of pulmonary vein arrhythmogenesis","volume":"9","author":"Lee","year":"2012","journal-title":"Heart Rhythm"},{"key":"B22","doi-asserted-by":"publisher","first-page":"980","DOI":"10.1016\/j.hrthm.2018.02.029","article-title":"Pulmonary vein activity does not predict the outcome of catheter ablation for persistent atrial fibrillation: a long-term multicenter prospective study","volume":"15","author":"Prabhu","year":"2018","journal-title":"Heart Rhythm"},{"key":"B23","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1111\/pace.13669","article-title":"Patient characteristics as predictors of recurrence of atrial fibrillation following cryoballoon ablation","volume":"42","author":"Bavishi","year":"2019","journal-title":"Pacing Clin Electrophysiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"993790","DOI":"10.3389\/fcvm.2022.993790","article-title":"Efficacy of left atrial low-voltage area-guided catheter ablation of atrial fibrillation: an updated systematic review and meta-analysis","volume":"9","author":"Zhou","year":"2022","journal-title":"Front Cardiovasc Med"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1150378\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T04:40:57Z","timestamp":1707712857000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1150378\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,12]]},"references-count":24,"alternative-id":["10.3389\/fcvm.2023.1150378"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2023.1150378","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,12]]},"article-number":"1150378"}}