Trial reportEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2023
Effect of fibrosis regionality on atrial fibrillation recurrence: insights from DECAAF II.
Trial report in 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, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it, 31 citations in OpenAlex.
- 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 · 2025Pooled it
- Regionalization of the atria for 3D electroanatomical mapping, cardiac imaging, and computational modelling: a clinical consensus statement of the European Heart Rhythm Association and the European Association of Cardiovascular Imaging of the ESC.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 · 2025Guideline
- 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 · 2025Trial
- Effect of fibrosis regionality on atrial fibrillation recurrence: insights from DECAAF II.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 · 2023Trial
- Atrial Cardiomyopathy: Pathophysiology, Diagnostic Approaches, and Prognostic Implications-A Narrative Review.Journal of clinical medicine · 2026Review
- Atrial Fibrillation Risk Management and Emerging Therapies.Journal of clinical medicine · 2026Review
- Quantitative detection of left atrial fibrosis in patients with atrial fibrillation: a comparative study of two 3D whole-heart late gadolinium enhancement sequences.The international journal of cardiovascular imaging · 2026Article
- Role of imaging techniques in monitoring atrial cardiomyopathy and atrial failure: a scientific statement.ESC heart failure · 2026Review
- Impact of Pulsed Field Ablation Dosing on Outcome After Pulmonary Vein Isolation Using a Pentaspline Ablation Catheter: A Prospective Comparison of 8 Versus 16 Applications.Journal of cardiovascular electrophysiology · 2026Article
- Predictive factors for atrial fibrillation recurrence after radiofrequency ablation: a multifactorial approach.BMC cardiovascular disorders · 2026Article
- A computed tomography-based radiomics-clinical model incorporating left atrial and proximal pulmonary vein features predicts recurrence after radiofrequency catheter ablation of atrial fibrillation: a multicenter study.Frontiers in medicine · 2026Article
- Systematic computational assessment of atrial function impairment due to fibrotic remodeling in electromechanical properties.PLoS computational biology · 2025Article
- Regional heterogeneity in left atrial stiffness impacts passive deformation in a cohort of patient-specific models.PLoS computational biology · 2025Article
- A framework of biomarkers for adipose tissue aging: a consensus statement by the Aging Biomarker Consortium.Life medicine · 2025Article
- Review
- Characterization of arrhythmia-induced cardiomyopathy using magnetic resonance imaging in patients with persistent atrial fibrillation and left ventricular systolic dysfunction - insights from DECAAF II.European journal of heart failure · 2025Article
- TGF-β-Driven Atrial Fibrosis in Atrial Fibrillation: From Mechanistic Insights to Targeted Therapies.Aging and disease · 2025Review
- Is regional atrial strain a useful surrogate of regional atrial fibrosis in atrial cardiomyopathy?European heart journal. Imaging methods and practice · 2025Article
- Glutathione peroxidase 4 as a potential biomarker for atrial fibrosis and recurrence of atrial fibrillation.Heart rhythm O2 · 2025Article
- Recurrence and non-improvement of European Heart Rhythm Association symptom scores after atrial fibrillation ablation: the role of left atrial fractal dimension.Quantitative imaging in medicine and surgery · 2025Article
Corrections and comments
- Commented on by
Authors and funding
12 authors at 3 institutions in 2 countries.
Funding
Abstract
aimsThe amount of fibrosis in the left atrium (LA) predicts atrial fibrillation (AF) recurrence after catheter ablation (CA). We aim to identify whether regional variations in LA fibrosis affect AF recurrence. METHODS AND
resultsThis post hoc analysis of the DECAAF II trial includes 734 patients with persistent AF undergoing first-time CA who underwent late gadolinium enhancement magnetic resonance imaging (LGE-MRI) within 1 month prior to ablation and were randomized to MRI-guided fibrosis ablation in addition to standard pulmonary vein isolation (PVI) or standard PVI only. The LA wall was divided into seven regions: anterior, posterior, septal, lateral, right pulmonary vein (PV) antrum, left PV antrum, and left atrial appendage (LAA) ostium. Regional fibrosis percentage was defined as a region's fibrosis prior to ablation divided by total LA fibrosis. Regional surface area percentage was defined as an area's surface area divided by the total LA wall surface area before ablation. Patients were followed up for a year with single-lead electrocardiogram (ECG) devices. The left PV had the highest regional fibrosis percentage (29.30 ± 14.04%), followed by the lateral wall (23.23 ± 13.56%), and the posterior wall (19.80 ± 10.85%). The regional fibrosis percentage of the LAA was a significant predictor of AF recurrence post-ablation (odds ratio = 1.017, P = 0.021), and this finding was only preserved in patients receiving MRI-guided fibrosis ablation. Regional surface area percentages did not significantly affect the primary outcome.
conclusionWe have confirmed that atrial cardiomyopathy and remodelling are not a homogenous process, with variations in different regions of the LA. Atrial fibrosis does not uniformly affect the LA, and the left PV antral region has more fibrosis than the rest of the wall. Furthermore, we identified regional fibrosis of the LAA as a significant predictor of AF recurrence post-ablation in patients receiving MRI-guided fibrosis ablation in addition to standard PVI.
Indexed as
Identifiers
What OpenQuestion holds
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.