The DOI matches its Crossref record; 128 of the 128 references it cites were found in a registry or an index.
Treatment of Atrial Fibrillation With Antiarrhythmic Drugs or Radiofrequency Ablation: Two Systematic Literature Reviews and Meta-Analyses
Abstract
BACKGROUND: Although radiofrequency catheter ablation (RFA) has evolved from an experimental procedure to an important treatment option for atrial fibrillation, the relative safety and efficacy of catheter ablation relative to that of antiarrhythmic drug (AAD) therapy has not been established. METHODS AND RESULTS: Two separate systematic reviews were conducted: one on RFA and the other on AAD to provide accurate and broadly representative estimates of the clinical efficacy and safety of both therapies in the treatment of atrial fibrillation. Electronic searches were conducted in EMBASE and MEDLINE from 1990 to 2007. For the RFA review, all study designs were accepted. For the AAD review, articles were limited to prospective studies on the following drugs of interest: amiodarone, dofetilide, sotalol, flecainide, and propafenone. Data were extracted by 1 reviewer, with a second reviewer performing independent confirmation of extracted data. Sixty-three RFA and 34 AAD studies were included in the reviews. Patients enrolled in RFA studies tended to be younger (mean age, 55 versus 62 years), had longer duration of atrial fibrillation (6.0 versus 3.1 years), and had failed a greater number of prior drug trials (2.6 versus 1.7). The single-procedure success rate of ablation off AAD therapy was 57% (95% CI, 50% to 64%), the multiple procedure success rate off AAD was 71% (95% CI, 65% to 77%), and the multiple procedure success rate on AAD or with unknown AAD usage was 77% (95% CI, 73% to 81%). In comparison, the success rate for AAD therapy was 52% (95% CI, 47% to 57%). A major complication of catheter ablation occurred in 4.9% of patients. Adverse events for AAD studies, although more common (30% versus 5%), were less severe. CONCLUSIONS: Studies of RFA for treatment of atrial fibrillation report higher efficacy rates than do studies of AAD therapy and a lower rate of complications.
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In the citing paper
“Catheter ablation of AF is effective in restoring and maintaining sinus rhythm in patients with symptomatic paroxysmal, persistent, and probably long-standing persistent AF -in general as second-line treatment after failure of or intolerance to antiarrhythmic drug therapy.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [713]
In the citing paper
“In such patients, catheter ablation is more effective than antiarrhythmic drug therapy.185,586,713,[717][718][719][720]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [713]
In the citing paper
“In patients who experience symptomatic recurrences of AF despite antiarrhythmic drug therapy, all RCTs showed better sinus rhythm maintenance with catheter ablation than on antiarrhythmic drugs.586,713,727,728”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [713]
In the citing paper
“Most patients require more than one procedure to achieve symptom control.713,726,728”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [713]
In the citing paper
“The rhythm outcome after catheter ablation of AF is difficult to predict in individual patients.173,227,713,728”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [713]
In the citing paper
“Sinus rhythm without severely symptomatic recurrences of AF is found in up to 70% of patients with paroxysmal AF, and around 50% in persistent AF. 713,728,735,1042”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [713]
In the citing paper
“a meta-analysis of the available (weak) evidence suggests slightly better prevention of recurrent AF in patients treated with antiarrhythmic drugs after catheter ablation.713”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [713]
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Items 401–500 of 847
Ngo, L., Woodman, R. J., Denman, R. A., Walters, T. E., Yang, I. A., & Ranasinghe, I. (2022) · European Heart Journal - Quality of Care and Clinical Outcomes · doi:10.1093/ehjqcco/qcac024 · Cited by 10
“20,21 In brief, we included patients aged ≥18 years hospitalized with a primary diagnosis of AF and a procedure code for catheter ablation from 2008 to 2017 and excluded those who (1) had secondary diagnoses of other arrhythmias to ensure that the ablation was solely for AF; (2) had a previous or current cardiac devic…”
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Ablation Versus Drugs: What Is the Best First-Line Therapy for Paroxysmal Atrial Fibrillation?
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MethodInfluentialRecent advances in rhythm control for atrial fibrillation
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“In addition, management of AF increases the cost of healthcare.(4,5,6) The mechanisms of AF are complex and are associated with electric and structural remodelling.”
BackgroundPulsed Field Ablation: a Novel Therapeutic Tool for Catheter-Based Treatment of Atrial Fibrillation
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Atrial Fibrillation: Pharmacological Therapy
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“Tiempo de escopia (min) 34,4 14,7 [9-81]”
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“therapy when performed in experienced centers [1,7,8], while success rates of pharmacological and interventional therapy are less satisfying in patients with persistent and long-stand-”
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“Whereas the single procedure drug-free success rate of PVI in paroxysmal AF ranges between 57 and 80 % [5–8], in contrast PVI in LSP-AF offers rather low success rates (21–22 %) [9–11].”
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“Even though the efficacy of AF ablation over multiple procedures is estimated to be 73–81% [14], the majority of patients who underwent AF ablation twice but experienced recurrence declined a third session.”
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Efficacy of catheter ablation for patients with atrial fibrillation and atrial septal defect
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“An autonomic response may occur in three different ways: (1) a vagal response (VR) characterized by immediate sinus bradycardia or atrioventricular block; [2] a marked shortening of the atrial RP nearby the stimulated GP; and [3] an initiation of sustained AF, either spontaneously or by a single atrial extrastimulus d…”
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Pulmonary vein isolation with the 30 and 35 mm high-density mesh ablator
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Atrial Fibrillation in Singapore and Malaysia: Current Trends and Future Prospects
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Complete antral encirclement is not required for pulmonary vein isolation
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“Focal point-by-point radiofrequency (RF) catheter ablation has demonstrated significant success in treating AF [2,3].”
BackgroundNon-pulmonary vein mediated atrial fibrillation: A novel sub-phenotype
Farrell, M., Yoneda, Z. T., Montgomery, J. A., Crawford, D. M., Wray, L. L., Xu, M., Kolek, M. J., Richardson, T. D., Lugo, R. M., Metawee, M., et al. (2017) · PLoS ONE · doi:10.1371/journal.pone.0184354 · Cited by 9
Predictors of recurrence after pulmonary vein isolation in patients with normal left atrial diameter
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Kommentar zu den Leitlinien der ESC zum Vorhofflimmern
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Frontier of catheter ablation for atrial fibrillation
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Role of Magnetic Resonance Imaging in Atrial Fibrillation Ablation
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Is AF Ablation Cost Effective?
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Catheter Ablation of Atrial Fibrillation – Techniques and Technology
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Surgical Strategies for Cardiac Perforation After Catheter Ablation or Electrophysiology Study
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Pulmonary vein isolation in the treatment of atrial fibrillation
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“56 Several randomized trials 57–60 and meta-analyses of randomized and nonrandomized studies 57,61–63 over the past decade have demonstrated the superiority of catheter ablation in terms of AF-free survival ( ∼ 71”
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Effectiveness of catheter ablation of atrial fibrillation according to heart failure etiology
Black‐Maier, E., Steinberg, B. A., Trulock, K. M., Wang, F. M., Lokhnygina, Y. V., O’Neal, W. K., Al‐Khatib, S. M., Atwater, B. D., Daubert, J. P., Frazier‐Mills, C. G., et al. (2020) · Journal of Arrhythmia · doi:10.1002/joa3.12291 · Cited by 7
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“All ablation procedures were classified into four groups: (1) atrial (atrial ectopics/atrial focal tachycardia, reentry atrial tachycardia, atrial flutter), (2) atrial fibrillation (AF) ablation, (3) supraventricular tachycardias (SVTs; slow pathway ablation in atrioventricular nodal reentrant tachycardia, overt acces…”
BackgroundSupraventricular and Ventricular Arrhythmias
Goel, R., Srivathsan, K. S., & Mookadam, M. (2013) · Primary Care Clinics in Office Practice · doi:10.1016/j.pop.2012.11.002 · Cited by 8
Catheter Ablation for Paroxysmal Atrial Fibrillation
Stevenson, W. G., & Albert, C. M. (2012) · New England Journal of Medicine · doi:10.1056/nejme1210548 · Cited by 8
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“However, this is associated with significant complications, with little evidence of clear survival benefits [5].”
BackgroundBarrio-López, M. T., Castellanos, E., Betancur-Gutiérrez, A., Zorita, B., Medina, J., Losada, N., del Valle, M. D., Sanchez, C., Crespo, R., Gonzalez, V., et al. (2022) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-022-01134-y · Cited by 7
“However, after the first ablation procedure, up to 30% of the patients suffer atrial fibrillation (AF) recurrences [5], mainly due to PV reconnections [6].”
BackgroundBatalov, R. E., Хлынин, М. С., Rogovskaya, Y., Sazonova, S. I., Tatarskiy, R. B., Anfinogenova, Y., & Popov, S. V. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12041254 · Cited by 7
“However, the overall effectiveness of procedures, according to different authors, rarely exceeds 80% [13].”
BackgroundStauffer, N., Knecht, S., Badertscher, P., Krisai, P., Hennings, E., Serban, T., Voellmin, G., Osswald, S., Sticherling, C., & Kühne, M. (2024) · EP Europace · doi:10.1093/europace/euae096 · Cited by 10
“2,3 Because the pulmonary veins (PVs) are recognized as the major trigger of AF, 1,4,5 CA primarily aims at sustained electrical isolation of PV (PVI) from the left atrium.”
BackgroundPappone, C., & Santinelli, V. (2012) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2011.12.023 · Cited by 7
Cryoballoon ablation in Chinese patients with paroxysmal atrial fibrillation: 1‐year follow‐up
Ling, T., Jin, Q., Pan, W., Zhang, N., Lin, C., Lee, H., & Wu, L. (2017) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.13157 · Cited by 8
Nonfluoroscopic catheter ablation in patients with atrial fibrillation
Валерьевич, С. О., Фаресовна, А. Д., Kostin, V. S., Uskach, T. M., Cherkashin, D. I., Grishin, I. Y., Бадиноковна, Б. К., Emelyanov, A. V., Kulikov, A. A., Nikolaeva, O. A., et al. (2020) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2020-3928 · Cited by 7
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Analysis of the ESC/EACTS 2020 Atrial Fibrillation Guidelines With Perioperative Implications
Nelson, J. A., Gue, Y. X., Christensen, J. M., Lip, G. Y. H., & Ramakrishna, H. (2021) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2021.05.011 · Cited by 8
Koniari, I. C., Artopoulou, E., Velissaris, D., Kounis, N. G., & Tsigkas, G. (2021) · PubMed Central · doi:10.11909/j.issn.1671-5411.2021.05.003 · Cited by 8
“Supplementary data from the FIRE AND ICE (radiofrequency vs cryoballoon-based therapy) trial of catheter ablation for AF showed that female sex had an almost 40% increase in the risk of atrial arrhythmia recurrence and cardiovascular rehospitalization after catheter ablation for AF, indicating the probable need for be…”
MethodDerivation and Verification of the Relationship between Ablation Index and Baseline Impedance
Cai, Z., Li, S., Zhang, Q., Wang, C., Jin, Z., Fu, M., Zhang, S., Liang, M., Wang, Z., & Han, Y. (2021) · Cardiology Research and Practice · doi:10.1155/2021/5574125 · Cited by 7
“,e lesion depths were theoretically the same if the current, impedance, and duration were invariant and the heat produced by the ablation catheter was constant [1].”
BackgroundDecision-making for recurrent atrial fibrillation after catheter ablation
Ko, J. S., Kim, S. S., Jeong, H. K., & Kim, N. (2023) · Cardiovascular Prevention and Pharmacotherapy · doi:10.36011/cpp.2023.5.e15 · Cited by 9
“LR has been reported to occur in 25% to 40% of cases, and this rate seems to vary among studies because of differences in patient population (paroxysmal vs. persistent, monitoring methods, follow-up duration, and study designs) [26,27].”
BackgroundGard, J. J., & Friedman, P. A. (2011) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2011.05.004 · Cited by 7
Diagnosis and Management of Atrial Fibrillation: An Overview
Romero, I., Nedios, S., & Kriatselis, C. (2014) · Cardiovascular Therapeutics · doi:10.1111/1755-5922.12090 · Cited by 7
“In addition, these drugs still do not have high effective rates in the long term and they are associated with gastrointestinal problems or other serious side effects such as HF, prolongation of the QT interval and ventricular arrhythmias [63].”
BackgroundBenson, B. E., Carrick, R. T., Habel, N., Bates, O. R. J., Bates, J. H. T., Bielau, P., & Spector, P. (2014) · EP Europace · doi:10.1093/europace/euu254 · Cited by 7
Advances in Atrial Fibrillation Ablation
Kowlgi, G. N., & Kapa, S. (2020) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2020.02.005 · Cited by 7
Lenhoff, H., Darpö, B., Ferber, G., Rosenqvist, M., & Frick, M. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.11.040 · Cited by 7
Pedrote, A. A., Acosta, J., Frutos‐López, M., Jáuregui, B., Alarcón, F., & Arana‐Rueda, E. (2019) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.13673 · Cited by 7
Cappato, R., Lévy, S., Providencia, R. A., Ali, H., Av, A., Barra, S., Creta, A., Farkowski, M. M., Heeger, C.-H. H., Kanagaratnam, P., et al. (2025) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.16561 · Cited by 6
Ablación de la fibrilación auricular en la vida real: ¿cuanto menos sabemos, más quemamos?
Pérez‐Villacastín, J., Pérez‐Castellano, N., Moreno, J., & Cañadas, V. (2012) · Revista Española de Cardiología · doi:10.1016/j.recesp.2012.07.007 · Cited by 6
Cunha, P. S., Teixeira, B. L., Laranjo, S. M., Portugal, G., Valente, B. T., Delgado, A. S., Pereira, M. B., Rocha, A. C., Brás, M., Cruz, M. C., et al. (2023) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2023.1309900 · Cited by 6
Catheter Ablation of Atrial Fibrillation: To Freeze, or Not to Freeze, That Is the Question
Fitzgerald, D. M. (2013) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.12275 · Cited by 6
Dizon, J. M., BIVIANO, A. B., Whang, W., EHLERT, F. A., & Garan, H. (2011) · EP Europace · doi:10.1093/europace/eur033 · Cited by 6
Trends in quantitative methods used for atrial fibrillation and ventricular tachycardia analyses
Ciaccio, E. J., BIVIANO, A. B., Iyer, V., & Garan, H. (2016) · Informatics in Medicine Unlocked · doi:10.1016/j.imu.2016.12.003 · Cited by 6
Catheter Ablation in the Treatment of Atrial Fibrillation
HESSELSON, A. B. (2020) · International Journal of Angiology · doi:10.1055/s-0040-1708476 · Cited by 6
Prednisone Ameliorates Atrial Inflammation and Fibrosis in Atrial Tachypacing Dogs
Zhang, H., Lai, Y., Zhou, H., Zou, L., Xu, Y., & Yin, Y. (2022) · International Heart Journal · doi:10.1536/ihj.21-249 · Cited by 6
Andrade, J. G., Chierchia, G., Kuniss, M., & Wazni, O. M. (2021) · EP Europace · doi:10.1093/europace/euab246 · Cited by 6
Escribano, P., Ródenas, J., García, M., Arias, M. A., Hidalgo, V. M., Calero, S., Rieta, J. J., & Alcaraz, R. (2022) · Journal of Personalized Medicine · doi:10.3390/jpm12101721 · Cited by 6
“In that case, catheter ablation (CA) has become a commonly used alternative [9] thanks to its superior ability over antiarrhythmic drugs for restoring SR in the midterm [10].”
BackgroundLi, G., Wang, X., Han, J., & Guo, X. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.1042573 · Cited by 6
Lee, K., Lee, S. K., Lee, J., Jeon, B. K., Kim, T., Yu, H. T., Lee, J., Park, J., Baek, Y., Kim, D., et al. (2023) · PLoS ONE · doi:10.1371/journal.pone.0280359 · Cited by 6
Atrial fibrillation fundamentals: from physiopathology to transcatheter ablation
Gaïta, F., Ferraris, F., Anselmino, M., & Calò, L. (2023) · European Heart Journal Supplements · doi:10.1093/eurheartjsupp/suad003 · Cited by 6
Escribano, P., Ródenas, J., García, M., Arias, M. A., Hidalgo, V. M., Calero, S., Rieta, J. J., & Alcaraz, R. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e25295 · Cited by 6
Borra, V., Mahadevan, A., Senapati, S. G., Vempati, R., Jaiswal, V., Borra, N., Ahmad, J., Herrera, O. R. Z., Vergara‐Sanchez, C., Prasad, T., et al. (2024) · IJC Heart & Vasculature · doi:10.1016/j.ijcha.2024.101466 · Cited by 6
“AF recurrence remains a notable challenge despite the procedure ’ s success, impacting 25 – 40 % of patients within a year [19].”
BackgroundNørgaard, M. W., Pedersen, P. U., & Bjerrum, M. B. (2014) · European Journal of Cardiovascular Nursing · doi:10.1177/1474515114548643 · Cited by 6
Shenasa, M., Shenasa, H., & Soleimanieh, M. (2014) · The Egyptian Heart Journal · doi:10.1016/j.ehj.2014.03.004 · Cited by 7
Prospectively Quantifying the Propensity for Atrial Fibrillation: A Mechanistic Formulation
Carrick, R. T., Bates, O. R. J., Benson, B. E., Habel, N., Bates, J. H. T., & Spector, P. (2015) · PLoS ONE · doi:10.1371/journal.pone.0118746 · Cited by 6
“encircling plus additional atrial ablation) [4],[8].”
BackgroundManaging atrial fibrillation in the global community: The European perspective
Kaba, R. A., Camm, A. J., Williams, T. M., & Sharma, R. (2013) · Global Cardiology Science and Practice · doi:10.5339/gcsp.2013.24 · Cited by 6
“One of these reviews concluded that studies of radiofrequency ablation report higher rates of success than studies of antiarrhythmic drugs with lower rates of complications.(48) The CACAF trial (Catheter Ablation for the Cure of Atrial Fibrillation) looked at 245 patients in which 137 patients Months 0 10 20 30 40 50”
ResultWhich is the Best Approach for Ablation of Long‐Standing Persistent Atrial Fibrillation?
Biase, L. D., Santangeli, P., BURKHARDT, J. D., & Natale, A. (2013) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.12209 · Cited by 6
Anand, R. G., Gorev, M. V., Poghosyan, H., Pothier, L. M., MAtkins, J., Kotler, G., Moroz, S., Armstrong, J. M., Nemtsov, S. V., & Orlov, M. V. (2016) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-016-0111-z · Cited by 6
Berger, W. R., Krul, S. P. J., van der Pol, J. A., van Dessel, P. F. H. M., Conrath, C. E., Wilde, A. A. M., & de Groot, J. R. (2015) · Journal of Cardiovascular Medicine · doi:10.2459/jcm.0000000000000274 · Cited by 6
The role of catheter ablation in the management of atrial fibrillation
Ang, R., & Earley, M. J. (2016) · Clinical Medicine · doi:10.7861/clinmedicine.16-3-267 · Cited by 6
Du, X., Guo, L., He, X., Jia, Y., Wu, J., Long, D., Yu, R., Sang, C., Liu, X., Yin, H., et al. (2017) · BMC Cardiovascular Disorders · doi:10.1186/s12872-017-0634-y · Cited by 6
D’Angelo, R. N., Rahman, M., Khanna, R., Yeh, R. W., Goldstein, L. J., Yadalam, S., Kalsekar, I. D., Tung, P., & ZIMETBAUM, P. J. (2021) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.15012 · Cited by 6
“Other studies have shown that many patients discontinue AADs after ablation, which aligns with our findings.(4,25)”
BackgroundResultKanaoka, K., Nishida, T., Nishioka, Y., Myojin, T., Kubo, S., Soeda, T., Okada, K., Noda, T., Iwanaga, Y., Miyamoto, Y., et al. (2022) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.15495 · Cited by 6
“Class IV 65 607 (24) 17 879 (26) 16 602 (25) 14 970 (22) 16 156 (24) <.”
Atrial Fibrillation in Hypertrophic Obstructive Cardiomyopathy - Antiarrhythmics, Ablation and More!
Malasana, G., Day, J. D., & Bunch, T. J. (2009) · Europe PMC (PubMed Central) · doi:10.4022/jafib.210 · Cited by 6
Impact of high-density mapping on outcome of the second ablation for atrial fibrillation
Ikeda, Y., Kato, R., Mori, H., Tsutsui, K., Goto, K., Nagase, T., Tanaka, S., Asano, S., Tawara, M., Yukino, M., et al. (2020) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-020-00716-y · Cited by 6
A New Catheter for Pulmonary Vein Isolation: The Hole Story?
WRIGHT, G. A., & Skanes, A. C. (2013) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.12240 · Cited by 6
Metadata
- Authors
- Calkins, H., Reynolds, M. R., Spector, P., Sondhi, M., Xu, Y., Martin, A., Williams, C. J., & Sledge, I.
- Affiliations
- University of Vermont (US)
- Venue
- Circulation Arrhythmia and Electrophysiology
- Published
- 2009-08
- Volume
- 2
- Issue
- 4
- Pages
- 349-361
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- OpenAlex
- W2020741490
- Cited by
- 847
- References
- 128
- Citations by year
- 2026: 19 · 2025: 29 · 2024: 42 · 2023: 33 · 2022: 38 · 2021: 48 · 2020: 35 · 2019: 37 · 2018: 43 · 2017: 54 · 2016: 62 · 2015: 63 · 2014: 72 · 2013: 69 · 2012: 74
- FWCI
- 43.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Arrhythmia and Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- atrial fibrillation, radiofrequency catheter ablation, antiarrhythmic drugs, amiodarone, dofetilide, sotalol, flecainide, propafenone, treatment efficacy, procedural complications, ablation success rate
- MeSH terms
- Anti-Arrhythmia Agents, Atrial Fibrillation, Humans, Catheter Ablation
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