Observational studyEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2025
Aggressive ablation vs. regular ablation for persistent atrial fibrillation: a multicentre real-world cohort study.
Observational study 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, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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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.
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Who cites it
3 citing papers in PubMed.
- Left atrial anterior wall ablation reduces the recurrence of atrial fibrillation in patients with aortic encroachment.Open heart · 2026Article
- Ablation of atrial fibrillation sources identified through sequential high-density mapping: in silico comparison against anatomy-based approaches.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 · 2026Article
- Vascular access site management during electrophysiology procedures: a European Heart Rhythm Association survey.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 · 2025Article
Corrections and comments
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Authors and funding
16 authors.
Funding
Abstract
aimsCurrent guidelines for the optimal ablation strategy for persistent atrial fibrillation (PerAF) remain unclear. While our previous RCT confirmed the favourable prognosis of aggressive ablation, real-world evidence is still lacking. METHODS AND
resultsAmong 4833 PerAF patients undergoing catheter ablation at 10 centres, two groups were defined: regular ablation (PVI-only or PVI plus anatomical ablation) and aggressive ablation (anatomical plus electrogram-guided ablation), with 1560 patients each after propensity score (PS) matching. The primary endpoint was 12-month AF/atrial tachycardia (AT) recurrence-free survival off anti-arrhythmic drugs after a single procedure. Additional PS matching was performed within the regular group between PVI-only and anatomical ablation (n = 455 each). Furthermore, anatomical ablation from the regular group was independently matched with aggressive ablation (n = 1362 each). At 12 months, the aggressive group showed superior AF/AT-free survival (66.2% vs. 59.3%, P < 0.001; HR 0.745), similar AT recurrence (12.0% vs. 11.3%, P = 0.539), and significantly higher procedural AF termination (67.0% vs. 21.0%, P < 0.001) than regular group. Moreover, patients with AF termination had improved AF/AT-free survival (72.3% vs. 55.2%, P < 0.001). Safety endpoints did not differ significantly between the two groups. Both the ablation outcomes and AF termination rate showed increasing trends with the extent of ablation aggressiveness but declined with extremely aggressive ablation. After additional PS matching, within the regular group, no statistical differences were observed though AF/AT-free survival in the anatomical group was slightly higher than the PVI-only group (60.7% vs. 55.6%, P = 0.122); while aggressive ablation showed improved AF/AT-free survival compared to anatomical ablation alone from regular group (67.5% vs. 59.9%, P < 0.001).
conclusionAggressive ablation achieved more favourable outcomes than regular ablation, and moderately aggressive ablation may be associated with better clinical outcomes. AF termination is a reliable ablation endpoint.
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