Evidence map›Paper›PMID 30587059›Full record

SynthesisJournal of the American Heart Association2019

Efficacy of Ablation Lesion Sets in Addition to Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation: Findings From the SMASH - AF Meta-Analysis Study Cohort.

Andrew Cluckey, Alexander C Perino, Fahd N Yunus, George C Leef, Mariam Askari, Paul A Heidenreich, Sanjiv M Narayan, Paul J Wang, Mintu P Turakhia

Open access · goldAbstract readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in Journal of the American Heart Association, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 2 pooled it
1.0field-weighted citation impact, top 20% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 16 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pulmonary vein isolation with or without empiric superior vena cava isolation in patients undergoing ablation for paroxysmal atrial fibrillation: the randomized ESVCI-AF trial.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025
    Trial
  4. Empiric superior vena cava isolation during first-time catheter ablation for paroxysmal atrial fibrillation: a systematic review and meta-analysis of randomized trials.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026
    Review
  5. Article
  6. The Ligament of Marshall: Far From Vestigial!Annals of thoracic surgery short reports · 2025
    Article
  7. Evolution in electrophysiology 100 years after Einthoven: translational and computational innovations in rhythm control of atrial fibrillation.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024
    Review
  8. Review
  9. Article
  10. Article
  11. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 1 country.

Andrew Cluckey1 Department of Medicine Stanford University School of Medicine Stanford CA.
Alexander C Perino1 Department of Medicine Stanford University School of Medicine Stanford CA.
Fahd N Yunus1 Department of Medicine Stanford University School of Medicine Stanford CA.
George C Leef1 Department of Medicine Stanford University School of Medicine Stanford CA.
Mariam Askari2 Veterans Affairs Palo Alto Health Care System Palo Alto CA.
Paul A Heidenreich1 Department of Medicine Stanford University School of Medicine Stanford CA.
Sanjiv M Narayan1 Department of Medicine Stanford University School of Medicine Stanford CA.
Paul J Wang1 Department of Medicine Stanford University School of Medicine Stanford CA.
Mintu P Turakhia1 Department of Medicine Stanford University School of Medicine Stanford CA.
Stanford University · USVA Palo Alto Health Care System · US

Funding

The Dynamics of Human Atrial FibrillationR01HL083359 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Sanjiv M Narayan · 2008 to 2026
$7.9M
The Maintenance of Human Atrial FibrillationK24HL103800 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI NARAYAN, SANJIV M · 2010 to 2019
$1.9M
NHLBI NIH HHS K24 HL103800NHLBI NIH HHS R01 HL083359
6 · The paper itself

Abstract

Background The objective was to explore the efficacy of ablation lesion sets in addition to pulmonary vein isolation ( PVI ) for paroxysmal atrial fibrillation. The optimal strategy for catheter ablation of paroxysmal atrial fibrillation is debated. Methods and Results The SMASH-AF (Systematic Review and Meta-analysis of Ablation Strategy Heterogeneity in Atrial Fibrillation) study cohort includes trials and observational studies identified in PubMed, Scopus, and Cochrane databases from January 1 1990, to August 1, 2016. We included studies reporting single procedure paroxysmal atrial fibrillation ablation success rates. Exclusion criteria included insufficient reporting of outcomes, ablation strategies that were not prespecified and uniform, and a sample size of fewer than 40 patients. We analyzed lesion sets performed in addition to PVI ( PVI plus) using multivariable random-effects meta-regression to control for patient, study, and procedure characteristics. The analysis included 145 total studies with 23 263 patients ( PVI- only cohort: 115 studies, 148 treatment arms, 16 500 patients; PVI plus cohort: 39 studies; 46 treatment arms, 6763 patients). PVI plus studies, as compared with PVI -only studies, included younger patients (56.7 years versus 58.8 years, P=0.001), fewer women (27.2% versus 32.0% women, P=0.002), and were more methodologically rigorous with longer follow-up (29.5 versus 17.1 months, P 0.004) and more randomization (19.4% versus 11.8%, P<0.001). In multivariable meta-regression, PVI plus studies were associated with improved success (7.6% absolute improvement [95% CI, 2.6-12.5%]; P<0.01, I

Indexed as

Atrial FibrillationCatheter AblationHeart Conduction SystemHumansPulmonary Veinsatrial fibrillationcatheter ablationmeta‐analysissuccess ratessystematic review

Identifiers

PMID30587059
PMCPMC6405732
OpenAlexW2906331445

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.