Trial reportEuropean heart journal2020
Catheter ablation vs. thoracoscopic surgical ablation in long-standing persistent atrial fibrillation: CASA-AF randomized controlled trial.
Trial report in European heart journal, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02755688 (Catheter Ablation Versus Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation), which is not on this map. Cited by 52 papers, 8 of them syntheses that pooled 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.
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.
Catheter Ablation Versus Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation (CASA-AF)
Who cites it
52 citing papers in PubMed, 8 syntheses or guidelines pooled it, 92 citations in OpenAlex.
- Hybrid versus endocardial ablation for persistent atrial fibrillation: a systematic review and Bayesian meta-analysis.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Pooled it
- Network meta-analysis of catheter ablation, rhythm control, and rate control strategies in atrial fibrillation with heart failure impact on mortality, cardiac function, and quality of life.Frontiers in medicine · 2025Pooled it
- Short- and long-term outcomes in isolated vs. hybrid thoracoscopic ablation in patients with atrial fibrillation: a systematic review and reconstructed individual patient data meta-analysis.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 · 2024Pooled it
- Mid term freedom from atrial fibrillation following hybrid ablation, a systematic review and meta analysis.Journal of cardiothoracic surgery · 2023Pooled it
- Biomarkers as predictors of recurrence of atrial fibrillation post ablation: an updated and expanded systematic review and meta-analysis.Clinical research in cardiology : official journal of the German Cardiac Society · 2022Pooled it
- Concomitant transcatheter occlusion versus thoracoscopic surgical clipping for left atrial appendage in patients undergoing ablation for atrial fibrillation: A meta-analysis.Frontiers in cardiovascular medicine · 2022Pooled it
- Prognostic value of heart rate variability in atrial fibrillation recurrence following catheter ablation: A systematic review and meta-analysis.Frontiers in cardiovascular medicine · 2022Pooled it
- Comparison of the Efficacy and Safety Endpoints of Five Therapies for Atrial Fibrillation: A Network Meta-Analysis.Frontiers in cardiovascular medicine · 2022Pooled it
- Left Atrial Function Predicts Atrial Arrhythmia Recurrence Following Ablation of Long-Standing Persistent Atrial Fibrillation.Circulation. Cardiovascular imaging · 2023Trial
- Cryoballoon vs. radiofrequency catheter ablation: insights from NOrwegian randomized study of PERSistent Atrial Fibrillation (NO-PERSAF study).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 · 2022Trial
- Building a surgical atrial fibrillation program: Programmatic evolution, safety, and three-year rhythm outcomes of hybrid ablation.Surgery open science · 2026Article
- Conventional and Emerging Biomarkers for Predicting Post-Ablation Atrial Fibrillation Recurrence: An Updated Systematic Review.Cardiology research · 2026Review
- Health Status Changes and Long-Term Clinical Outcomes in Patients With Atrial Fibrillation.JAMA network open · 2026Article
- A Retrospective Long-Term Follow-Up of the Randomized Study: Total Endoscopic Ablation of Patients With Long-Standing Persistent Atrial Fibrillation.Interdisciplinary cardiovascular and thoracic surgery · 2026Observational
- Intraprocedural atrial flutter transition predicts arrhythmia-free survival after "2C3L Plus" ablation for long-standing persistent atrial fibrillation.Frontiers in cardiovascular medicine · 2026Article
- Position paper of the Polish Society of Cardiothoracic Surgeons and the Heart Rhythm Association of the Polish Society of Cardiology on atrial fibrillation hybrid management.Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic surgery · 2025Article
- Minimally Invasive Surgical Strategies for the Treatment of Atrial Fibrillation: An Evolving Role in Contemporary Cardiac Surgery.Journal of cardiovascular development and disease · 2025Review
- Unsupervised Clustering of Patients Undergoing Thoracoscopic Ablation Identifies Relevant Phenotypes for Advanced Atrial Fibrillation.Diagnostics (Basel, Switzerland) · 2025Article
- Efficacy and safety of different forms of ablation therapies and antiarrhythmic drugs in atrial fibrillation: a systematic review and network meta-analysis of randomized clinical trials.Journal of thoracic disease · 2025Article
- Enhancing ablation outcomes: vein of Marshall ethanol infusion in persistent atrial fibrillation with severe left atrial enlargement.Frontiers in cardiovascular medicine · 2025Article
Corrections and comments
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Authors and funding
29 authors at 9 institutions in 3 countries.
Funding
Abstract
aimsLong-standing persistent atrial fibrillation (LSPAF) is challenging to treat with suboptimal catheter ablation (CA) outcomes. Thoracoscopic surgical ablation (SA) has shown promising efficacy in atrial fibrillation (AF). This multicentre randomized controlled trial tested whether SA was superior to CA as the first interventional strategy in de novo LSPAF. METHODS AND
resultsWe randomized 120 LSPAF patients to SA or CA. All patients underwent predetermined lesion sets and implantable loop recorder insertion. Primary outcome was single procedure freedom from AF/atrial tachycardia (AT) ≥30 s without anti-arrhythmic drugs at 12 months. Secondary outcomes included clinical success (≥75% reduction in AF/AT burden); procedure-related serious adverse events; changes in patients' symptoms and quality-of-life scores; and cost-effectiveness. At 12 months, freedom from AF/AT was recorded in 26% (14/54) of patients in SA vs. 28% (17/60) in the CA group [OR 1.128, 95% CI (0.46-2.83), P = 0.83]. Reduction in AF/AT burden ≥75% was recorded in 67% (36/54) vs. 77% (46/60) [OR 1.13, 95% CI (0.67-4.08), P = 0.3] in SA and CA groups, respectively. Procedure-related serious adverse events within 30 days of intervention were reported in 15% (8/55) of patients in SA vs. 10% (6/60) in CA, P = 0.46. One death was reported after SA. Improvements in AF symptoms were greater following CA. Over 12 months, SA was more expensive and provided fewer quality-adjusted life-years (QALYs) compared with CA (0.78 vs. 0.85, P = 0.02).
conclusionSingle procedure thoracoscopic SA is not superior to CA in treating LSPAF. Catheter ablation provided greater improvements in symptoms and accrued significantly more QALYs during follow-up than SA. CLINICAL
trial registrationISRCTN18250790 and ClinicalTrials.gov: NCT02755688.
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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.