{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T21:28:18Z","timestamp":1768080498737,"version":"3.49.0"},"reference-count":34,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2023,7,15]],"date-time":"2023-07-15T00:00:00Z","timestamp":1689379200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: CLOSE-guided pulmonary vein isolation (PVI) is based on contiguous and optimized (Ablation Index-guided) radiofrequency lesions. The efficacy of CLOSE-guided PVI in persistent atrial fibrillation (AF) treatment has been poorly evaluated. Methods: In two centers, 50 patients eligible for persistent AF ablation underwent CLOSE-guided PVI (Ablation Index \u2265 450 at the anterior wall, \u2265300 at posterior wall, intertag distance \u2264 6 mm). If PVI failed to restore sinus rhythm (SR), electrical cardioversion (ECV) was performed. Atrial substrate modification (ASM) was performed only if PVI and ECV failed to restore SR. Recurrence was defined as any recorded episode of AF, atrial tachycardia (AT) or atrial flutter (AFL) &gt; 30 s on Holter electrocardiographs at 3, 6 and 12 months. Results: From the 50 patients (64 \u00b1 10 years, 14% long-standing persistent AF), SR was restored by ECV in 34 patients (68%) 56 \u00b1 38 days prior to ablation. On the day of ablation, 42 patients (84%) were on class I-III anti-arrhythmic drug therapy (ADT) and the rhythm was AF in 23\/50 patients. PVI was achieved in all patients; after PVI, ECV was required in 21 patients and ASM in 1 patient. The mean procedure time, radiofrequency time and fluoroscopy time were 141 \u00b1 33 min, 23 \u00b1 7 min and 7 \u00b1 6 min, respectively. At 12 months, single-procedure freedom from AF\/AT\/AFL was 80%, with 19 patients (38%) receiving class I-III ADT. Conclusions: In a population of patients with persistent AF monitored with intermittent cardiac rhythm recordings, CLOSE-guided PVI resulted in high single-procedure arrhythmia-free survival at 1 year. Future large-scale studies involving continuous cardiac monitoring are necessary.<\/jats:p>","DOI":"10.3390\/jcm12144698","type":"journal-article","created":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T00:56:47Z","timestamp":1689555407000},"page":"4698","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["CLOSE-Guided Pulmonary Vein Isolation to Treat Persistent Atrial Fibrillation: 1-Year Outcome"],"prefix":"10.3390","volume":"12","author":[{"given":"Philippe","family":"Taghji","sequence":"first","affiliation":[{"name":"Electrophysiology Unit, Cardiology Department, La Timone University Hospital, 13005 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Claude","family":"Deharo","sequence":"additional","affiliation":[{"name":"Electrophysiology Unit, Cardiology Department, La Timone University Hospital, 13005 Marseille, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sana","family":"Amraoui","sequence":"additional","affiliation":[{"name":"Electrophysiology Unit, Cardiology Department, American Hospital of Paris, 92200 Neuilly-sur-Seine, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3016-9192","authenticated-orcid":false,"given":"Sok-Sithikun","family":"Bun","sequence":"additional","affiliation":[{"name":"Electrophysiology Unit, Cardiology Department, Pasteur University Hospital, 06000 Nice, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,15]]},"reference":[{"key":"ref_1","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_2","first-page":"1303","article-title":"Contemporary management of patients undergoing atrial fibrillation ablation: In-hospital and 1-year follow-up findings from the ESC-EHRA atrial fibrillation ablation long-term registry","volume":"38","author":"Arbelo","year":"2017","journal-title":"Eur. Heart J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1161\/CIRCEP.114.001943","article-title":"Five-year outcome of catheter ablation of persistent atrial fibrillation using termination of atrial fibrillation as a procedural endpoint","volume":"8","author":"Scherr","year":"2015","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_4","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_5","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1093\/eurheartj\/ehu001","article-title":"The Atrial Fibrillation Ablation Pilot Study: An European Survey on Methodology and results of catheter ablation for atrial fibrillation conducted by the European Heart Rhythm Association","volume":"35","author":"Arbelo","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1596","DOI":"10.1093\/europace\/euv323","article-title":"Current ablation techniques for persistent atrial fibrillation: Results of the European Heart Rhythm Association Survey","volume":"17","author":"Dagres","year":"2015","journal-title":"Europace"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1093\/europace\/euaa157","article-title":"Standardized pulmonary vein isolation workflow to enclose veins with contiguous lesions: The multicentre VISTAX trial","volume":"22","author":"Duytschaever","year":"2020","journal-title":"Europace"},{"key":"ref_8","first-page":"1077","article-title":"Composite Index Tagging for PVI in Paroxysmal AF: A Prospective, Multicenter Postapproval Study","volume":"8","author":"Monir","year":"2022","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1111\/pace.12386","article-title":"Ultrasound-Guided Venous Puncture in Electrophysiological Procedures: A Safe Method, Rapidly Learned","volume":"37","author":"Errahmouni","year":"2014","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_10","first-page":"99","article-title":"Evaluation of a strategy aiming to enclose the pulmonary veins with contiguous and optimized radiofrequency lesions in paroxysmal atrial fibrillation: A pilot study","volume":"4","author":"Taghji","year":"2018","journal-title":"J. Am. Coll. Cardiol. EP"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1111\/j.1540-8167.2005.40624.x","article-title":"Methods to Determine Bidirectional Block of the Cavotricuspid Isthmus in Radiofrequency Ablation of Typical Atrial Flutter","volume":"16","author":"Saoudi","year":"2005","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1093\/europace\/euq252","article-title":"A simple and definite proof of complete cavotricuspid isthmus block","volume":"12","author":"Latcu","year":"2010","journal-title":"Europace"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1111\/j.1540-8159.2005.09516.x","article-title":"Predictive value of early atrial fibrillation recurrence after circumferential pulmonary vein ablation","volume":"28","author":"Bertaglia","year":"2005","journal-title":"Pace Clin. Electrophysiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1093\/europace\/eup331","article-title":"Long-term results and the predictors of outcome of catheter ablation of atrial fibrillation using steerable sheath catheter navigation after single procedure in 674 patients","volume":"12","author":"Arya","year":"2009","journal-title":"Europace"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1111\/j.1540-8167.2009.01504.x","article-title":"Does Left Atrial Volume and Pulmonary Venous Anatomy Predict the Outcome of Catheter Ablation of Atrial Fibrillation?","volume":"20","author":"Hof","year":"2009","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1093\/europace\/eux013","article-title":"Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: A meta-analysis","volume":"20","author":"Njoku","year":"2018","journal-title":"Europace"},{"key":"ref_17","first-page":"f366","article-title":"Outcomes of persistent and long-standing persistent atrial fibrillation ablation: A systematic review and meta-analysis","volume":"20","author":"Brooks","year":"2017","journal-title":"Europace"},{"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","volume":"11","author":"Hussein","year":"2018","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_19","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":"2018","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2592","DOI":"10.1111\/jce.14673","article-title":"Clinical outcome of pulmonary vein isolation alone ablation strategy using VISITAG SURPOINT in nonparoxysmal atrial fibrillation","volume":"31","author":"Yamaguchi","year":"2020","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1694","DOI":"10.1111\/jce.14531","article-title":"Reproducibility of pulmonary vein isolation guided by the ablation index: 1-year outcome of the AIR registry","volume":"31","author":"Stabile","year":"2020","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.hrthm.2020.12.023","article-title":"Marshall bundle elimination, Pulmonary vein isolation, and Line completion for ANatomical ablation of persistent atrial fibrillation (Marshall-PLAN): Prospective, single-center study","volume":"18","author":"Derval","year":"2020","journal-title":"Heart Rhythm."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1093\/eurheartj\/ehx666","article-title":"PulmOnary vein isolation With vs. without continued antiarrhythmic Drug trEatment in subjects with Recurrent Atrial Fibrillation (POWDER AF): Results from a multicentre randomized trial","volume":"39","author":"Duytschaever","year":"2017","journal-title":"Eur. Heart J."},{"key":"ref_24","unstructured":"Duytschaever, M. (2023, February 01). Pulmonary Vein Iisolation with Versus without Continued Antiarrhythmic Drugs in Persistent Aatrial Fibrillation (POWDER-AF2). ClinicalTrials.gov Identifier: NCT03437356, Available online: https:\/\/classic.clinicaltrials.gov\/ct2\/show\/NCT03437356."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1056\/NEJMoa021328","article-title":"A Comparison of Rate Control and Rhythm Control in Patients with Atrial Fibrillation","volume":"347","author":"Wyse","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1016\/S0735-1097(97)00220-9","article-title":"Adverse Effects of Low Dose Amiodarone: A Meta-Analysis","volume":"30","author":"Vorperian","year":"1997","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","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","volume":"4","author":"Boveda","year":"2018","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e005767","DOI":"10.1161\/CIRCEP.117.005767","article-title":"Laser Balloon or Wide-Area Circumferential Irrigated Radiofrequency Ablation for Persistent Atrial Fibrillation: A Multicenter Prospective Randomized Study","volume":"10","author":"Schmidt","year":"2017","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.hrthm.2014.09.063","article-title":"Pulmonary vein isolation as index procedure for persistent atrial fibrillation: One-year clinical outcome after ablation using the second-generation cryoballoon","volume":"12","author":"Ciconte","year":"2015","journal-title":"Heart Rhythm."},{"key":"ref_30","doi-asserted-by":"crossref","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":"ref_31","doi-asserted-by":"crossref","first-page":"e003273","DOI":"10.1161\/CIRCINTERVENTIONS.115.003273","article-title":"Occupational Health Risks in Cardiac Catheterization Laboratory Workers","volume":"9","author":"Andreassi","year":"2016","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Tu, C.Y., Lin, C.J., Yang, B.H., Wu, J., and Wu, T.H. (2020). Cardiac catheterization real-time dynamic radiation dose measurement to estimate lifetime attributable risk of cancer. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0234461"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e003596","DOI":"10.1161\/CIRCEP.115.003596","article-title":"Randomized Study of Persistent Atrial Fibrillation Ablation: Ablate in Sinus Rhythm Versus Ablate Complex-Fractionated Atrial Electrograms in Atrial Fibrillation","volume":"9","author":"Bassiouny","year":"2016","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1161\/CIRCULATIONAHA.112.098079","article-title":"A Comprehensive Evaluation of Rhythm Monitoring Strategies for the Detection of Atrial Fibrillation Recurrence: Insights from 647 continuously monitored patients and implications for monitoring after therapeutic interventions","volume":"126","author":"Charitos","year":"2012","journal-title":"Circulation"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/14\/4698\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:12:32Z","timestamp":1760127152000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/14\/4698"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,15]]},"references-count":34,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["jcm12144698"],"URL":"https:\/\/doi.org\/10.3390\/jcm12144698","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,15]]}}}