Evidence map›Paper›PMID 38703164›Full record

Observational studyJACC. Clinical electrophysiology2024

Catheter Ablation as First-Line Therapy in Persistent Atrial Fibrillation: Patient Characteristics and Clinical Outcomes.

Michael Barkagan, Anat Milman, Guy Zahavi, Arwa Younis, Bishnu Dhakal, Sanjay Dixit, Christopher X Wong, Edward P Gerstenfeld, Sanjiv M Narayan, Jared T Bunch and 9 more

Abstract readObservational StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in JACC. Clinical electrophysiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
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

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

19 authors.

Michael BarkaganDivision of Cardiovascular Medicine, Cardiac Electrophysiology Institute, Shamir Medical Center, Be'er Yaakov, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Anat MilmanDivision of Cardiovascular Medicine, Cardiac Electrophysiology Institute, Shamir Medical Center, Be'er Yaakov, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Guy ZahaviDepartment of Anesthesia, Raphael Hospital, Tel-Aviv, Israel.
Arwa YounisCardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Bishnu DhakalCardiac Electrophysiology Section, Department of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Sanjay DixitCardiac Electrophysiology Section, Department of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Christopher X WongSection of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA.
Edward P GerstenfeldSection of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California-San Francisco, San Francisco, California, USA.
Sanjiv M NarayanDepartment of Cardiovascular Medicine, Stanford University, Stanford, California, USA.
Jared T BunchDivision of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA.
Lukasz CerbinSection of Electrophysiology, Division of Cardiology, University of Colorado Hospital, Aurora, Colorado, USA.
Wendy S TzouSection of Electrophysiology, Division of Cardiology, University of Colorado Hospital, Aurora, Colorado, USA.
Mark MetzlNorthShore University Health System, Evanston, Illinois, USA.
Aqeel KhananiCardiology and Cardiac Electrophysiology, Advent Health Orlando, Orlando, Florida, USA.
Usman R SiddiquiCardiology and Cardiac Electrophysiology, Advent Health Orlando, Orlando, Florida, USA.
Sanghamitra MohantyTexas Cardiac Arrhythmia Institute, Austin, Texas, USA.
Andrea NataleTexas Cardiac Arrhythmia Institute, Austin, Texas, USA; Department of Biomedicine and Prevention, Division of Cardiology, University of Tor Vergata, Rome, Italy.
Aaron MedinaDivision of Cardiovascular Medicine, Cardiac Electrophysiology Institute, Shamir Medical Center, Be'er Yaakov, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Elad AnterDivision of Cardiovascular Medicine, Cardiac Electrophysiology Institute, Shamir Medical Center, Be'er Yaakov, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: eladanter@gmail.com.

Funding

The Dynamics of Human Atrial FibrillationR01HL083359 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI Sanjiv M Narayan · 2008 to 2026
$7.9M
Patient-Directed Computational Analysis of Atrial FibrillationR01HL122384 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN DIEGO · PI WOUTER-JAN RAPPEL · 2015 to 2026
$5.3M
Machine Learning in Atrial FibrillationR01HL149134 · NHLBI · STANFORD UNIVERSITY · PI NARAYAN, SANJIV M · 2020 to 2024
$3.8M
NHLBI NIH HHS R01 HL083359NHLBI NIH HHS R01 HL122384NHLBI NIH HHS R01 HL149134
6 · The paper itself

Abstract

backgroundIn patients with persistent atrial fibrillation (PerAF), antiarrhythmic drugs (AADs) are considered a first-line rhythm-control strategy, whereas catheter ablation is a reasonable alternative.

objectivesThis study sought to examine the prevalence, patient characteristics, and clinical outcomes of patients with PerAF who underwent catheter ablation as a first or second-line strategy.

methodsThis multicenter observational study included consecutive patients with PerAF who underwent first-time ablation between January 2020 and September 2021 in 9 medical centers in the United States. Patients were divided into those who underwent ablation as first-line therapy and those who had ablation as second-line therapy. Patient characteristics and clinical outcomes were compared between the groups.

resultsA total of 2,083 patients underwent first-time ablation for PerAF. Of these, 1,086 (52%) underwent ablation as a first-line rhythm-control treatment. Compared with patients treated with AADs as first-line therapy, these patients were predominantly male (72.6% vs 68.1%; P = 0.03), with a lower frequency of hypertension (64.0% vs 73.4%; P < 0.001) and heart failure (19.1% vs 30.5%; P < 0.001). During a mean follow-up of 325.9 ± 81.6 days, arrhythmia-free survival was similar between the groups (HR: 1.13; 95% CI: 0.92-1.41); however, patients in the second-line ablation strategy were more likely to continue receiving AAD therapy (41.5% vs 15.9%; P < 0.001).

conclusionsA first-line ablation strategy for PerAF is prevalent in the United States, particularly in men with fewer comorbidities. More data are needed to identify patients with PerAF who derive benefit from an early intervention strategy.

Indexed as

Anti-Arrhythmia AgentsAtrial FibrillationCatheter AblationAgedFemaleHumansMaleMiddle AgedTreatment OutcomeUnited StatesAnti-Arrhythmia Agentsantiarrhythmic drugsatrial fibrillationcatheter ablationclinical outcomesrhythm controltreatment strategy

Identifiers

PMID38703164
PMCPMC12199792

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Registered trials

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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.