{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T11:52:42Z","timestamp":1783338762762,"version":"3.54.6"},"reference-count":32,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,12]],"date-time":"2023-01-12T00:00:00Z","timestamp":1673481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81870301"],"award-info":[{"award-number":["81870301"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82270365"],"award-info":[{"award-number":["82270365"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: For patients with persistent atrial fibrillation (AF), whether linear ablation should be performed remains controversial, and the efficacy and safety for ablation index (AI)-guided high-energy linear ablation of mitral isthmus (MI) and left atrial (LA) posterior box isolation is still unclear. The aims of this study were to assess the feasibility and clinical success rate of pulmonary veins isolation (PVI) combined with linear ablation of LA roof and posterior inferior (posterior wall isolation) and MI compare with the PVI-alone method in patients of persistent AF. Methods and results: 362 consecutive persistent AF patients were enrolled from two electrophysiology centers. A total of 200 cases were in PVI-plus group and 162 cases were in PVI-alone group. The PVI-alone group received wide circumferential isolation of both ipsilateral pulmonary veins. PVI combined with linear ablation of left atrial posterior wall isolation (LAPWI)and MI were performed in the PVI-plus group. The primary study end point was the first recurrence of an atrial arrhythmia. After 24 months, freedom from the primary endpoint was achieved in 73.5% of the patients in the PVI-plus group and 62.5% in the PVI-alone group (hazard ratio = 0.62, 95% confidence interval: 0.43\u20130.91, log rank p = 0.012). The procedure-related complication rates were 2.5% in PVI-plus group and 1.9% in PVI-alone group (p = 0.808). Conclusion: In this study, the ablation strategy of ablation (PVI plus linear ablation of mitral isthmus and posterior box isolation) was feasible and safe for persistent AF patients. Compared with the PVI-alone method, it improved outcomes in patients with persistent AF.<\/jats:p>","DOI":"10.3390\/jcm12020619","type":"journal-article","created":{"date-parts":[[2023,1,13]],"date-time":"2023-01-13T02:29:57Z","timestamp":1673576997000},"page":"619","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Efficacy and Safety Ablation Index-Guided High-Energy Linear Ablation for Persistent Atrial Fibrillation: PVI Plus Linear Ablation of Mitral Isthmus and Posterior Box Isolation"],"prefix":"10.3390","volume":"12","author":[{"given":"Xi","family":"Li","sequence":"first","affiliation":[{"name":"Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China"},{"name":"Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China"},{"name":"Hubei Key Laboratory of Cardiology, Wuhan 430060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China"},{"name":"Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China"},{"name":"Hubei Key Laboratory of Cardiology, Wuhan 430060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China"},{"name":"Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China"},{"name":"Hubei Key Laboratory of Cardiology, Wuhan 430060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinlin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan 430060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Wuhan Asian Heart Hospital, Wuhan 430060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China"},{"name":"Cardiovascular Research Institute, Wuhan University, Wuhan 430060, China"},{"name":"Hubei Key Laboratory of Cardiology, Wuhan 430060, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1161\/hc0902.104712","article-title":"Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation","volume":"105","author":"Oral","year":"2002","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1093\/europace\/eus027","article-title":"2012 HRS\/EHRA\/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design","volume":"14","author":"Calkins","year":"2012","journal-title":"Europace"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2871","DOI":"10.1093\/eurheartj\/ehl093","article-title":"Substrate modification combined with pulmonary vein isolation improves outcome of catheter ablation in patients with persistent atrial fibrillation: A prospective randomized comparison","volume":"27","author":"Willems","year":"2006","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1798","DOI":"10.1093\/europace\/euv067","article-title":"Prospective randomized comparison between a fixed \u20182C3L\u2019 approach vs. stepwise approach for catheter ablation of persistent atrial fibrillation","volume":"17","author":"Dong","year":"2015","journal-title":"Europace"},{"key":"ref_5","doi-asserted-by":"crossref","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":"ref_6","doi-asserted-by":"crossref","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":"ref_7","doi-asserted-by":"crossref","first-page":"e005114","DOI":"10.1161\/CIRCEP.117.005114","article-title":"Stand-Alone Pulmonary Vein Isolation Versus Pulmonary Vein Isolation with Additional Substrate Modification as Index Ablation Procedures in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation: The Randomized Alster-Lost-AF Trial (Ablation at St. Georg Hospital for Long-Standing Persistent Atrial Fibrillation)","volume":"10","author":"Fink","year":"2017","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.ijcard.2020.05.032","article-title":"The value of extensive catheter linear ablation on persistent atrial fibrillation (the CLEAR-AF Study)","volume":"316","author":"Yao","year":"2020","journal-title":"Int. J. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","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":"ref_10","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.hrthm.2003.12.001","article-title":"A review of the coronary venous system: A road less travelled","volume":"1","author":"Ho","year":"2004","journal-title":"Heart Rhythm"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1161\/01.CIR.101.6.647","article-title":"The anatomic basis of connections between the coronary sinus musculature and the left atrium in humans","volume":"101","author":"Chauvin","year":"2000","journal-title":"Circulation"},{"key":"ref_13","first-page":"565","article-title":"Pulmonary vein isolation alone vs. more extensive ablation with defragmentation and linear ablation of persistent atrial fibrillation: The EARNEST-PVI trial","volume":"23","author":"Inoue","year":"2021","journal-title":"EP Eur."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.1016\/j.jacc.2012.04.060","article-title":"Catheter ablation of long-standing persistent atrial fibrillation: 5-year outcomes of the Hamburg Sequential Ablation Strategy","volume":"60","author":"Tilz","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.hrthm.2010.10.015","article-title":"Comparison of voltage map-guided left atrial anterior wall ablation versus left lateral mitral isthmus ablation in patients with persistent atrial fibrillation","volume":"8","author":"Pak","year":"2011","journal-title":"Heart Rhythm"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1161\/CIRCEP.109.924878","article-title":"Circumferential pulmonary vein ablation with additional linear ablation results in an increased incidence of left atrial flutter compared with segmental pulmonary vein isolation as an initial approach to ablation of paroxysmal atrial fibrillation","volume":"3","author":"Sawhney","year":"2010","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s10840-018-0420-5","article-title":"Safety and efficacy of atrial fibrillation ablation guided by Ablation Index module","volume":"54","author":"Solimene","year":"2019","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e006576","DOI":"10.1161\/CIRCEP.118.006576","article-title":"Use of Ablation Index-Guided Ablation Results in High Rates of Durable Pulmonary Vein Isolation and Freedom from Arrhythmia in Persistent Atrial Fibrillation Patients: The PRAISE Study Results","volume":"11","author":"Hussein","year":"2018","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_19","first-page":"710","article-title":"High-power short duration vs. conventional radiofrequency ablation of atrial fibrillation: A systematic review and meta-analysis","volume":"23","author":"Ravi","year":"2021","journal-title":"EP Eur."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.hrthm.2018.11.031","article-title":"Low complication rates using high power (45\u201350 W) for short duration for atrial fibrillation ablations","volume":"16","author":"Winkle","year":"2019","journal-title":"Heart Rhythm"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.ijcard.2013.08.083","article-title":"Benefits and risks of additional ablation of complex fractionated atrial electrograms for patients with atrial fibrillation: A systematic review and meta-analysis","volume":"169","author":"Wu","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2996","DOI":"10.1161\/01.CIR.0000146917.75041.58","article-title":"Technique and results of linear ablation at the mitral isthmus","volume":"110","author":"Hocini","year":"2004","journal-title":"Circulation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1274","DOI":"10.1111\/j.1540-8167.2006.00645.x","article-title":"Anatomic characteristics of the left atrial isthmus in patients with atrial fibrillation: Lessons from computed tomographic images","volume":"17","author":"Chiang","year":"2006","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1111\/j.1540-8167.2011.02112.x","article-title":"Completion of mitral isthmus ablation using a steerable sheath: Prospective randomized comparison with a nonsteerable sheath","volume":"22","author":"Matsuo","year":"2011","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1016\/j.hrthm.2021.06.1202","article-title":"Epicardial course of the musculature related to the great cardiac vein: Anatomical considerations and clinical implications for mitral isthmus block after vein of Marshall ethanol infusion","volume":"18","author":"Pambrun","year":"2021","journal-title":"Heart Rhythm"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3176","DOI":"10.1161\/01.CIR.0000074206.52056.2D","article-title":"Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy","volume":"107","author":"Lin","year":"2003","journal-title":"Circulation"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.ijcard.2014.12.035","article-title":"Does isolation of the left atrial posterior wall improve clinical outcomes after radiofrequency catheter ablation for persistent atrial fibrillation?: A prospective randomized clinical trial","volume":"181","author":"Kim","year":"2015","journal-title":"Int. J. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1740","DOI":"10.1016\/j.hrthm.2020.05.005","article-title":"Durability of posterior wall isolation after catheter ablation among patients with recurrent atrial fibrillation","volume":"17","author":"Markman","year":"2020","journal-title":"Heart Rhythm"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.hrthm.2020.11.008","article-title":"Epicardial course of the septopulmonary bundle: Anatomical considerations and clinical implications for roof line completion","volume":"18","author":"Pambrun","year":"2021","journal-title":"Heart Rhythm"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1111\/j.1540-8167.2012.02370.x","article-title":"Is pursuit of termination of atrial fibrillation during catheter ablation of great value in patients with longstanding persistent atrial fibrillation?","volume":"23","author":"Park","year":"2012","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1253\/circj.CJ-21-0326","article-title":"Different Determinants of the Recurrence of Atrial Fibrillation and Adverse Clinical Events in the Mid-Term Period After Atrial Fibrillation Ablation","volume":"86","author":"Watanabe","year":"2022","journal-title":"Circ. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1093\/eurheartj\/ehm027","article-title":"Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation","volume":"28","author":"Berruezo","year":"2007","journal-title":"Eur. Heart J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/2\/619\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:04:27Z","timestamp":1760119467000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/2\/619"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,12]]},"references-count":32,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["jcm12020619"],"URL":"https:\/\/doi.org\/10.3390\/jcm12020619","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,12]]}}}