SynthesisCirculation. Arrhythmia and electrophysiology2023
Temporal Trends and Lesion Sets for Persistent Atrial Fibrillation Ablation: A Meta-Analysis With Trial Sequential Analysis and Meta-Regression.
Synthesis in Circulation. Arrhythmia and electrophysiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
What it found
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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
16 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Ethanol Infusion in the Vein of Marshall for Persistent Atrial Fibrillation Ablation: Evidence From Randomized Controlled Trials.Journal of cardiovascular electrophysiology · 2025Pooled it
- Durable effectiveness and safety of hybrid ablation versus catheter ablation: 2-year results from the randomized CEASE-AF trial†.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2025Trial
- Clinical Outcomes of High Density Voltage and Fractionation Mapping-Guided Ablation in Patients With Persistent Atrial Fibrillation.Journal of arrhythmia · 2026Article
- Characterisation and Enhanced Residual Risk Stratification of Long-Term Post-Discharge Ischaemic Events After Atrial Fibrillation Catheter Ablation.TH open : companion journal to thrombosis and haemostasis · 2026Article
- Outcomes after redo ablation for the recurrence of atrial fibrillation: a systematic review and meta-analysis.Clinical research in cardiology : official journal of the German Cardiac Society · 2025Article
- Atrial fibrillation nomenclature, definitions, and mechanisms: Position paper from the international Working Group of the Signal Summit.Heart rhythm · 2025Review
- The Extent of Pulmonary Vein Electrical Connections Predicts the Success of Stand-Alone Pulmonary Vein Isolation in Persistent Atrial Fibrillation.Journal of cardiovascular electrophysiology · 2025Article
- Impact of atrial fibrillation diagnosis-to-ablation time on 24-month efficacy and safety outcomes in the Cryo Global Registry.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 · 2025Observational
- Left atrial appendage electrical isolation in long-standing persistent atrial fibrillation: Lupus in fabula.Heart rhythm O2 · 2025Article
- Catheter Ablation in Atrial Fibrillation: Recent Advances.Journal of clinical medicine · 2024Review
- 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.Journal of arrhythmia · 2024Article
- 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2024Article
- 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation 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 · 2024Article
- Hybrid ablation for persistent atrial fibrillation: a narrative review.Journal of thoracic disease · 2024Review
- Hybrid Endo-Epicardial Therapies for Advanced Atrial Fibrillation.Journal of clinical medicine · 2024Review
- What Cannot be Missed: Important Publications on Electrophysiology in 2023.Arrhythmia & electrophysiology review · 2024Article
Corrections and comments
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Authors and funding
11 authors.
Funding
Abstract
backgroundAblation for persistent atrial fibrillation (PsAF) has been performed for over 20 years, although success rates have remained modest. Several adjunctive lesion sets have been studied but none have become standard of practice. We sought to describe how the efficacy of ablation for PsAF has evolved in this time period with a focus on the effect of adjunctive ablation strategies.
methodsDatabases were searched for prospective studies of PsAF ablation. We performed meta-regression and trial sequential analysis.
resultsA total of 99 studies (15 424 patients) were included. Ablation for PsAF achieved the primary outcome (freedom of atrial fibrillation/atrial tachycardia rate at 12 months follow-up) in 48.2% (5% CI, 44.0-52.3). Meta-regression showed freedom from atrial arrhythmia at 12 months has improved over time, while procedure time and fluoroscopy time have significantly reduced. Through the use of cumulative meta-analyses and trial sequential analysis, we show that some ablation strategies may initially seem promising, but after several randomized controlled trials may be found to be ineffective. Trial sequential analysis showed that complex fractionated atrial electrogram ablation is ineffective and further study of this treatment would be futile, while posterior wall isolation currently does not have sufficient evidence for routine use in PsAF ablation.
conclusionsOverall success rates from PsAF ablation and procedure/fluoroscopy times have improved over time. However, no adjunctive lesion set, in addition to pulmonary vein isolation, has been conclusively demonstrated to be beneficial. Through the use of trial sequential analysis, we highlight the importance of adequately powered randomized controlled trials, to avoid reaching premature conclusions, before widespread adoption of novel therapies.
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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.