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Use of pulmonary vein isolation (PVI) alone has reasonably high clinical efficacy in paroxysmal atrial fibrillation (AF) but lower efficacy for persistent AF. A search for adjunctive therapies or ablations that would improve outcomes of PVI in patients with persistent AF has been unproductive so far (NEJM JW Cardiol Jul 27 2022 and JAMA 2022; 327:2296; NEJM JW Cardiol May 29 2022 and JACC Clin Electrophysiol 2020; 6:958 and 970).
In the current randomized trial, investigators assessed the efficacy of adding posterior wall isolation to PVI in 338 patients undergoing first-time ablation for symptomatic persistent AF. All patients underwent 3D mapping with radiofrequency ablation. The primary endpoint was freedom from any documented atrial arry…