Evidence map›Paper›PMID 35727277›Full record

Trial reportJAMA2022

Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation: The DECAAF II Randomized Clinical Trial.

Nassir F Marrouche, Oussama Wazni, Christopher McGann, Tom Greene, J Michael Dean, Lilas Dagher, Eugene Kholmovski, Moussa Mansour, Francis Marchlinski, David Wilber and 13 more

Registry-linked trialOpen access · bronzeAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in JAMA, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02529319 (Efficacy of Delayed Enhancement MRI-Guided Ablation vs Conventional Catheter Ablation of Atrial Fibrillation), which is not on this map. Cited by 223 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
223citing papers in PubMed, 12 pooled it
54.2field-weighted citation impact, top 1% 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.

NCT02529319 nacompletednot on this map

Efficacy of Delayed Enhancement MRI-Guided Ablation vs Conventional Catheter Ablation of Atrial Fibrillation: The DECAAF II Study

TypeinterventionalSponsorTulane University School of MedicineRan2016 to 2021Enrolled843ConditionsAtrial Fibrillation, FibrosisArmsMRI-Guided Ablation, Conventional Ablation
3 · Its place in the literature

Who cites it

223 citing papers in PubMed, 12 syntheses or guidelines pooled it, 358 citations in OpenAlex.

  1. Pooled it
  2. Prevalence and multiple predictors of left atrial low voltage in paroxysmal and non-paroxysmal atrial fibrillation patients undergoing ablation: a systematic review and 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 · 2025
    Pooled it
  3. Guideline
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pulmonary vein isolation plus adjunctive therapy for the treatment of atrial fibrillation: a systematic review and meta-analysis.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2024
    Pooled it
  8. Guideline
  9. Guideline
  10. SCMR expert consensus statement for cardiovascular magnetic resonance of patients with a cardiac implantable electronic device.Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance · 2024
    Guideline
  11. Pooled it
  12. Comparison of cryoballoon and radiofrequency ablation for persistent atrial fibrillation: a systematic review and meta-analysis.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2023
    Pooled it
  13. Indirect treatment comparison of two pulsed field ablation systems for the treatment of persistent atrial fibrillation.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026
    Trial
  14. Personalized pulmonary vein isolation guided by left atrial wall thickness for persistent atrial fibrillation ablation: the PeAF-by-LAWT randomized 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
  15. Repeat in situ ablation vs. extensive ablation for recurrent persistent 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 · 2025
    Trial
  16. Circumferential pulmonary vein isolation with adjunctive linear ablation vs. circumferential pulmonary vein isolation alone for long-standing persistent atrial fibrillation: a randomized pilot 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 · 2025
    Trial
  17. Persistent atrial fibrillation with left atrial low-voltage area: who benefit from additional modification?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
  18. Trial
  19. Trial
  20. Sex-specific outcomes and left atrial remodeling following catheter ablation of persistent atrial fibrillation: results from the DECAAF II trial.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2024
    Trial

163 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

23 authors at 15 institutions in 4 countries.

Nassir F MarroucheCardiology Department, Tulane University School of Medicine, New Orleans, Louisiana.
Oussama WazniCleveland Clinic, Cleveland, Ohio.
Christopher McGannSwedish Center, Seattle, Washington.
Tom GreeneUniversity of Utah, Salt Lake City.
J Michael DeanUniversity of Utah, Salt Lake City.
Lilas DagherCardiology Department, Tulane University School of Medicine, New Orleans, Louisiana.
Eugene KholmovskiCardiology Department, Johns Hopkins Medicine, Baltimore, Maryland.
Moussa MansourCardiology Department, Massachusetts General Hospital, Boston.
Francis MarchlinskiCardiology Department, University of Pennsylvania, Philadelphia.
David WilberCardiology Department, Loyola University Chicago, Chicago, Illinois.
Gerhard HindricksCardiology Department, Leipzig University, Leipzig, Germany.
Christian MahnkopfKlinikum Coburg, Coburg, Germany.
Darryl WellsSwedish Center, Seattle, Washington.
Pierre JaisCardiology Department, Segalen University, Bordeaux, France.
Prashanthan SandersCardiology Department, Adelaide Medical School, Adelaide, Australia.
Johannes BrachmannKlinikum Coburg, Coburg, Germany.
Jeroen J BaxCardiology Department, Leiden University Medical Center, Leiden, the Netherlands.
Leonie Morrison-de BoerUniversity of Utah, Salt Lake City.
Thomas DenekeHeart Center Bad Neustadt, Bad Neustadt, Germany.
Hugh CalkinsCardiology Department, Johns Hopkins University, Baltimore, Maryland.
Christian SohnsHeart and Diabetes Center NRW, Bad Oeynhausen, Germany.
Nazem AkoumCardiology Department, University of Washington Medical Center, Seattle.
DECAAF II Investigators
Klinikum Coburg · DEJohns Hopkins University · USSwedish Medical Center · USTulane University · USUniversity of Utah · USCleveland Clinic · USHeart and Diabetes Center North Rhine-Westphalia · DELeipzig University · DELoyola University Chicago · USMassachusetts General Hospital · USRhön-Klinikum · DEThe University of Adelaide · AUUniversity of Pennsylvania · USUniversity of Washington Medical Center · USLeiden University Medical Center · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Importance: Ablation of persistent atrial fibrillation (AF) remains a challenge. Left atrial fibrosis plays an important role in the pathophysiology of AF and has been associated with poor procedural outcomes. Objective: To investigate the efficacy and adverse events of targeting atrial fibrosis detected on magnetic resonance imaging (MRI) in reducing atrial arrhythmia recurrence in persistent AF. Design, Setting, and Participants: The Efficacy of Delayed Enhancement-MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation of Atrial Fibrillation trial was an investigator-initiated, multicenter, randomized clinical trial involving 44 academic and nonacademic centers in 10 countries. A total of 843 patients with symptomatic or asymptomatic persistent AF and undergoing AF ablation were enrolled from July 2016 to January 2020, with follow-up through February 19, 2021. Interventions: Patients with persistent AF were randomly assigned to pulmonary vein isolation (PVI) plus MRI-guided atrial fibrosis ablation (421 patients) or PVI alone (422 patients). Delayed-enhancement MRI was performed in both groups before the ablation procedure to assess baseline atrial fibrosis and at 3 months postablation to assess for ablation scar. Main Outcomes and Measures: The primary end point was time to first atrial arrhythmia recurrence after a 90-day blanking period postablation. The primary safety composite outcome was defined by the occurrence of 1 or more of the following events within 30 days postablation: stroke, PV stenosis, bleeding, heart failure, or death. Results: Among 843 patients who were randomized (mean age 62.7 years; 178 [21.1%] women), 815 (96.9%) completed the 90-day blanking period and contributed to the efficacy analyses. There was no significant difference in atrial arrhythmia recurrence between groups (fibrosis-guided ablation plus PVI patients, 175 [43.0%] vs PVI-only patients, 188 [46.1%]; hazard ratio [HR], 0.95 [95% CI, 0.77-1.17]; P = .63). Patients in the fibrosis-guided ablation plus PVI group experienced a higher rate of safety outcomes (9 [2.2%] vs 0 in PVI group; P = .001). Six patients (1.5%) in the fibrosis-guided ablation plus PVI group had an ischemic stroke compared with none in PVI-only group. Two deaths occurred in the fibrosis-guided ablation plus PVI group, and the first one was possibly related to the procedure. Conclusions and Relevance: Among patients with persistent AF, MRI-guided fibrosis ablation plus PVI, compared with PVI catheter ablation only, resulted in no significant difference in atrial arrhythmia recurrence. Findings do not support the use of MRI-guided fibrosis ablation for the treatment of persistent AF. Trial Registration: ClinicalTrials.gov Identifier: NCT02529319.

Indexed as

Ablation TechniquesAtrial FibrillationFibrosisHeart AtriaMagnetic Resonance ImagingSurgery, Computer-AssistedCatheter AblationFemaleHumansMaleMiddle AgedPulmonary VeinsRecurrenceTreatment Outcome

Identifiers

PMID35727277
PMCPMC9214588
OpenAlexW4283212737

What OpenQuestion holds

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Registered trials

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.