PMC:6019327 / 377837-379302 JSONTXT

{"project":"2_test","denotations":[{"id":"28506916-15928285-29308903","span":{"begin":168,"end":171},"obj":"15928285"},{"id":"28506916-15928285-29308903","span":{"begin":168,"end":171},"obj":"15928285"},{"id":"28506916-23094720-29308904","span":{"begin":172,"end":175},"obj":"23094720"},{"id":"28506916-23094720-29308904","span":{"begin":172,"end":175},"obj":"23094720"},{"id":"28506916-24549549-29308905","span":{"begin":176,"end":179},"obj":"24549549"},{"id":"28506916-24549549-29308905","span":{"begin":176,"end":179},"obj":"24549549"},{"id":"28506916-26163901-29308906","span":{"begin":290,"end":293},"obj":"26163901"},{"id":"28506916-26163901-29308906","span":{"begin":290,"end":293},"obj":"26163901"},{"id":"28506916-23094720-45814963","span":{"begin":390,"end":393},"obj":"23094720"},{"id":"28506916-23094720-45814963","span":{"begin":390,"end":393},"obj":"23094720"},{"id":"28506916-24549549-45814964","span":{"begin":1273,"end":1276},"obj":"24549549"},{"id":"28506916-24549549-45814964","span":{"begin":1273,"end":1276},"obj":"24549549"},{"id":"T59072","span":{"begin":168,"end":171},"obj":"15928285"},{"id":"T43860","span":{"begin":168,"end":171},"obj":"15928285"},{"id":"T34633","span":{"begin":172,"end":175},"obj":"23094720"},{"id":"T46724","span":{"begin":172,"end":175},"obj":"23094720"},{"id":"T96746","span":{"begin":176,"end":179},"obj":"24549549"},{"id":"T99055","span":{"begin":176,"end":179},"obj":"24549549"},{"id":"T68568","span":{"begin":290,"end":293},"obj":"26163901"},{"id":"T9634","span":{"begin":290,"end":293},"obj":"26163901"},{"id":"T57225","span":{"begin":390,"end":393},"obj":"23094720"},{"id":"T49484","span":{"begin":390,"end":393},"obj":"23094720"},{"id":"T34199","span":{"begin":1273,"end":1276},"obj":"24549549"},{"id":"T83016","span":{"begin":1273,"end":1276},"obj":"24549549"},{"id":"T17291","span":{"begin":168,"end":171},"obj":"15928285"},{"id":"T9369","span":{"begin":168,"end":171},"obj":"15928285"},{"id":"T89247","span":{"begin":172,"end":175},"obj":"23094720"},{"id":"T48372","span":{"begin":172,"end":175},"obj":"23094720"},{"id":"T8629","span":{"begin":176,"end":179},"obj":"24549549"},{"id":"T16028","span":{"begin":176,"end":179},"obj":"24549549"},{"id":"T41632","span":{"begin":290,"end":293},"obj":"26163901"},{"id":"T95745","span":{"begin":290,"end":293},"obj":"26163901"},{"id":"T32007","span":{"begin":390,"end":393},"obj":"23094720"},{"id":"T97620","span":{"begin":390,"end":393},"obj":"23094720"},{"id":"T9716","span":{"begin":1273,"end":1276},"obj":"24549549"},{"id":"T29688","span":{"begin":1273,"end":1276},"obj":"24549549"}],"text":"There have been several studies performed to investigate the role of AF ablation as first-line therapy, prior to a trial of a membrane-active antiarrhythmic medication.377,378,379 The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF)494 trial compared catheter ablation with AAD therapy for the first-line therapy of symptomatic PAF.378 The trial did not show a reduction in the cumulative AF burden over 2 years; however, catheter ablation was associated with a lower rate of AF recurrence (15% vs 29%, P =.004) and a similar rate of complications (17% vs 15%) compared with AAD. The unexpected result in the MANTRA-PAF might be explained by the ablation techniques with discretional circumferential ablation without confirmation of PVI with a circular mapping catheter as well as by the choice of reduction in AF burden on 7-day Holter as a primary endpoint. Reductions in AF burden on a short 7-day Holter can be difficult to demonstrate in a paroxysmal population. In the Radiofrequency Ablation versus Antiarrhythmic drugs as First-line Treatment of Paroxysmal AF (RAAFT-2) trial, PV antrum isolation was performed using irrigated-tip ablation catheters confirmed by recordings from a circular mapping catheter.379 The results of the RAAFT-2 demonstrated that AF or AT recurred in 55% of the catheter ablation group compared with 72% of the patients in the AAD group after a 2-year follow-up (P = .016)."}