Evidence map›Paper›PMID 39264394›Full record

ArticleJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2025

Direct-to-catheter ablation versus second line catheter ablation for persistent atrial fibrillation: Effect on arrhythmia recurrence, AF burden, early left atrium remodeling and quality of life.

Hadi Younes, Besim Ademi, Eli Tsakiris, Han Feng, Amitabh C Pandey, Mario Mekhael, Charbel Noujaim, Chanho Lim, Lilas Dagher, Abdel Hadi El Hajjar and 13 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing 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

2 citing papers in PubMed.

  1. Pre-ablation rate control therapy and direct-to-catheter ablation in patients with persistent atrial fibrillation: A DECAAF II subanalysis.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026
    Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors.

Hadi YounesTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Besim AdemiTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Eli TsakirisTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Han FengTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Amitabh C PandeyTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Mario MekhaelTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Charbel NoujaimTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Chanho LimTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Lilas DagherTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Abdel Hadi El HajjarTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Ghassan BidaouiTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Mayana BsoulTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Ala AssafTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Swati RaoTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Christian MahnkopfDepartment of Cardiology, Klinikum Coburg, Coburg, Germany.
Ghaith ShamailehTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Omar KreidiehTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Abboud HassanTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Yinshuo LiuTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Yishi JiaTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Francisco T PoloTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Nassir F MarroucheTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA.
Eoin DonnellanTulane Research Innovation for Arrhythmia Discovery (TRIAD), Cardiac Electrophysiology, Tulane University School of Medicine, New Orleans, LA, USA. edonnellan@tulane.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCatheter ablation has obtained class 1 indication in ablation of young, healthy patients with symptomatic paroxysmal atrial fibrillation (AF). Anti-arrhythmic drugs (AADs) remain first-line therapy before ablating persistent AF (PersAF). We sought to evaluate the efficacy of a direct-to-catheter ablation approach against catheter ablation post AADs in PersAF.

methodsIn this DECAAF II subanalysis, patients were stratified into two subgroups: 'Direct-to-catheter' group comprising patients who had not received AADs prior to ablation, and'second-line ablation' group, comprising patients who had been on any AAD therapy at any time before ablation. Patients were followed over 18 months. The primary outcome was AF recurrence. Secondary outcomes included AF burden, quality of life (QoL) that assessed by the AFSS and SF-36 scores, and changes in the left atrial volume index (LAVI) assessed by LGE-MRI scans.

resultsThe analysis included 815 patients, with 279 classified as'direct-to-catheter' group and 536 classified as'Second-line ablation' group. The primary outcome was similar between both groups (44.8% vs 44.4%, p > 0.05), as was AF burden (20% vs 16%, p > 0.05). Early remodeling, reflected by LAVI reduction, was similar between the groups (9.1 [1.6-18.0] in the second-line ablation group and 9.5 [2.5-19.7] in the direct-to-catheter group, p > 0.05). QoL pre/post ablation was also similar (p > 0.05). On multivariate analysis, history of AAD was not predictive of AF recurrence(p > 0.05).

conclusionPrior AAD therapy demonstrated minimal impact on atrial remodeling and QoL improvement, in addition to limited benefit on AF recurrence and burden post-ablation in patients with PersAF. Additional studies are warranted to explore the efficacy of catheter ablation as a first-line therapy in PersAF.

Indexed as

Atrial FibrillationAtrial RemodelingCatheter AblationQuality of LifeAgedAnti-Arrhythmia AgentsFemaleHumansMaleMiddle AgedRecurrenceTreatment OutcomeAnti-Arrhythmia AgentsDirect-to-catheter ablationHistory of anti-arrhythmic drugsPersistent atrial fibrillationSecond-line Ablation

Identifiers

PMID39264394
PMCPMC12245940

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.