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 Cardiology2025
Repeat in situ ablation vs. extensive ablation for recurrent persistent atrial fibrillation.
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, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.
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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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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.
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Who cites it
5 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Ethanol infusion of the vein of marshall-based strategies for persistent atrial fibrillation: a systematic review and meta-analysis of randomized trials.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 · 2026Pooled it
- Algorithm-guided personalized pulsed field ablation for persistent atrial fibrillation: a prospective multicentre study with matched external comparison.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
- A bidirectional relationship between atrial fibrillation and depression: epidemiology, mechanisms, and clinical implications.Frontiers in psychiatry · 2026Review
- Clarifying the definition and handling of the early post-ablation period in studies of persistent 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 · 2025Article
- Repeat ablation for persistent atrial fibrillation: what lies beyond lines and veins?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
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11 authors.
Funding
Abstract
aimsRepeat ablation strategies for persistent atrial fibrillation (PerAF) are less well studied than initial ablation strategies. The efficacy of repeat ablation remains unclear, particularly regarding the potential advantages of extra-pulmonary vein (PV) extensive ablation compared with in situ ablation. METHODS AND
resultsPatients with recurrent PerAF were randomized (1:1) to receive extra-PV extensive ablation (EXT group, n = 66) or repeat PV isolation (PVI) and linear ablation as the first procedure (in situ group, n = 66). The primary endpoint was freedom from atrial fibrillation (AF)/atrial tachycardia (AT) episodes lasting >30 s at 12 months. At 12 months, 44 patients (66.7%) in the EXT group were free from AF/AT recurrence, in contrast to 32 patients (48.5%) in the in situ group [log-rank P = 0.037; hazard ratio (HR) 0.587 (95% confidence interval (CI), 0.348-0.992)]. The freedom from AF recurrence rate was significantly higher in the EXT group than in the in situ group [77.3% vs. 60.6%, log-rank P = 0.027; HR 0.509 (95% CI, 0.278-0.932)].The safety endpoints showed no significant difference between the two groups (4.5% vs. 6.1%, P = 0.716).
conclusionAmong patients with PerAF undergoing repeat ablation, the EXT group demonstrated superior clinical efficacy compared with the in situ group, indicating that PV reconnection and linear lesion reconduction may not constitute the predominant mechanisms driving AF recurrence. These may still contribute significantly, but targeting additional non-PV substrates further improves outcomes.
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