Evidence map›Paper›PMID 41491358›Full record

ArticleJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2026

Pre-ablation rate control therapy and direct-to-catheter ablation in patients with persistent atrial fibrillation: A DECAAF II subanalysis.

Radia Ksayer, Hadi Younes, Eli Tsakiris, Bella Gonzalez Perez, Yishi Jia, Alina Upreti, Ghassan Bidaoui, Christian Massad, Amitabh C Pandey, Han Feng and 1 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, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from 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.

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

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

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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

11 authors.

Radia KsayerTulane Research Innovation for Arrhythmia Discovery, New Orleans, 1430 Tulane Avenue, LA, 70112, USA.
Hadi YounesTulane Research Innovation for Arrhythmia Discovery, New Orleans, 1430 Tulane Avenue, LA, 70112, USA.
Eli TsakirisTulane Research Innovation for Arrhythmia Discovery, New Orleans, 1430 Tulane Avenue, LA, 70112, USA.
Bella Gonzalez PerezTulane Research Innovation for Arrhythmia Discovery, New Orleans, 1430 Tulane Avenue, LA, 70112, USA.
Yishi JiaTulane Research Innovation for Arrhythmia Discovery, New Orleans, 1430 Tulane Avenue, LA, 70112, USA.
Alina UpretiTulane Research Innovation for Arrhythmia Discovery, New Orleans, 1430 Tulane Avenue, LA, 70112, USA.
Ghassan BidaouiTulane Research Innovation for Arrhythmia Discovery, New Orleans, 1430 Tulane Avenue, LA, 70112, USA.
Christian MassadTulane Research Innovation for Arrhythmia Discovery, New Orleans, 1430 Tulane Avenue, LA, 70112, USA.
Amitabh C PandeyTulane Research Innovation for Arrhythmia Discovery, New Orleans, 1430 Tulane Avenue, LA, 70112, USA.
Han FengTulane Research Innovation for Arrhythmia Discovery, New Orleans, 1430 Tulane Avenue, LA, 70112, USA.
Nassir F MarroucheTulane Research Innovation for Arrhythmia Discovery, New Orleans, 1430 Tulane Avenue, LA, 70112, USA. nmarrouche@tulane.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundFor patients with persistent atrial fibrillation (PersAF), initial treatment strategies often involve rate or rhythm control before offering ablation. This study compared two approaches: (1) catheter ablation without prior medication (referred to as direct-to-catheter ablation, DTCA) and (2) catheter ablation after initial rate control with either diltiazem or metoprolol.

objectiveThis study included two independentanalyses of patients with persistent atrial fibrillation (PersAF) undergoing catheter ablation. Aimed at evaluating the potential impact of pre-ablation rate control medications including beta blockers and calcium channel blockers on post-ablation outcomes. Comparison 1: DTCA without prior beta-blocker use (n = 209) vs. metoprolol use prior to ablation (n = 260). Comparison 2: DTCA without prior calcium channel blocker use (n = 639) vs. diltiazem use prior to ablation (n = 55).

methodsPatients were followed for 18 months to evaluate primary outcome: recurrence of atrial fibrillation (AF) and secondary outcomes: Pre-ablation and Post-ablation left atrial percent fibrosis as seen on LGE MRI and Quality of life (QoL), measured with the SF-36 questionnaire. The Wilcoxon tests were conducted to compare the QoL and fibrosis among groups. Time to recurrence among the groups post ablation was assessed via Kaplan-Meier curves. Multivariable Cox models were developed to adjust for other confounders of AF recurrence.

resultsIn the beta-blocker analysis (n = 469), no significant difference in AF recurrence was observed between patients without prior beta-blocker use (DTCA group) and those treated with metoprolol (Kaplan-Meier, p > 0.05). Similarly, in the calcium channel blocker analysis (n = 694), no difference in recurrence was found between the DTCA group and those with prior diltiazem use (p > 0.05). Multivariable Cox models confirmed that neither metoprolol (p = 0.44) nor diltiazem (p = 0.34) independently predicted AF recurrence. Additionally, no significant differences were found in imaging metrics or QoL between the groups in either comparison (all p > 0.05).

conclusionPrior treatment with diltiazem or metoprolol before ablation of PersAF did not show additional benefits in reducing patient outcomes such as AF recurrence, fibrosis, or improving QoL.

Indexed as

Atrial FibrillationCatheter AblationMetoprololAdrenergic beta-AntagonistsAgedAnti-Arrhythmia AgentsBridge TherapyCalcium Channel BlockersDiltiazemFemaleHumansMaleMiddle AgedQuality of LifeRecurrenceTreatment OutcomeAdrenergic beta-AntagonistsAnti-Arrhythmia AgentsCalcium Channel BlockersDiltiazemMetoprololAblationAFIBAF recurrenceBeta blockerCCBRate control

Identifiers

PMID41491358
PMCPMC13645899

What OpenQuestion holds

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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.