{
  "abstract": "Background and Aims: Currently, no standard approach exists for substrate ablation in persistent atrial fibrillation (AF). This study aimed to assess whether repeat pulmonary vein isolation (Re-PVI) plus targeted substrate ablation improves long-term outcomes compared with Re-PVI alone in patients with persistent AF undergoing a second ablation. Methods: The AF-CAM study is an investigator-initiated, prospective, randomized, open-label, blinded-endpoint, multi-center clinical trial. Patients with persistent AF undergoing a second ablation for arrhythmia recurrence were randomized 1:1 to either Group A (Re-PVI alone) or Group B (Re-PVI plus targeted ablation). The primary endpoint was freedom from any atrial arrhythmia (>30 s) between 3 and 12 months of follow-up. Results: Between August 2021 and November 2023, 56 patients (mean age 68 ± 10 years, 32% women) were randomized before the trial was terminated prematurely. There was no evidence of a difference in arrhythmia recurrence between the treatment groups (hazard ratio [HR] for recurrence, Group B vs. Group A: 1.07; 95% confidence interval [CI] 0.50 to 2.33; p = 0.85). Pulmonary vein reconnection was present in 86% of patients and was not associated with the risk of atrial arrhythmia recurrence (HR 0.927, 95% CI [0.275, 3.120]). Across both groups, catheter ablation was associated with improvements in quality of life (AFEQT score) and reductions in BNP levels during follow-up. Conclusions: In this prematurely terminated randomized trial, adding CFA- and DOA-guided substrate ablation to Re-PVI did not demonstrate an improvement in freedom from atrial arrhythmia compared with Re-PVI alone. The small sample size and imprecise treatment estimate preclude a definitive conclusion about the efficacy of the adjunctive strategy. AFEQT scores increased and BNP levels decreased over follow-up in the studied patients. Larger studies are needed to further evaluate the complex atrial substrate in persistent AF.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiology and Intensive Care Medicine, Faculty of Medicine, Semmelweis University Campus Hamburg, Asklepios Hospital St. Georg, 20099 Hamburg, Germany",
    "Atrial Fibrillation Network (AFNET), 48149 Münster, Germany",
    "Asklepios Proresearch, Research Institute, 20099 Hamburg, Germany",
    "Evangelical Hospital Duesseldorf, 40217 Duesseldorf, Germany",
    "Heart Center, Cologne University Hospital, 50937 Cologne, Germany",
    "Medical School Hamburg, 20457 Hamburg, Germany"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 15,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Stephan Willems"
    },
    {
      "affs": [
        0
      ],
      "name": "Pawel Kuklik",
      "orcid": "0000-0001-8440-654X"
    },
    {
      "affs": [
        2
      ],
      "name": "Peter Wohlmuth"
    },
    {
      "affs": [
        0
      ],
      "name": "Melanie A. Gunawardene",
      "orcid": "0000-0001-7561-7185"
    },
    {
      "affs": [
        0
      ],
      "name": "Jens Hartmann"
    },
    {
      "affs": [
        0
      ],
      "name": "Jannis Dickow"
    },
    {
      "affs": [
        0
      ],
      "name": "Tim Harloff",
      "orcid": "0009-0000-1506-5366"
    },
    {
      "affs": [
        0
      ],
      "name": "Kathrin Heitmann"
    },
    {
      "affs": [
        3
      ],
      "name": "Christian Meyer",
      "orcid": "0000-0003-0217-3960"
    },
    {
      "affs": [
        3
      ],
      "name": "Katharina Scherschel",
      "orcid": "0000-0002-3237-140X"
    },
    {
      "affs": [
        0
      ],
      "name": "Susanne Scholz"
    },
    {
      "affs": [
        0,
        4
      ],
      "name": "Arian Sultan"
    },
    {
      "affs": [
        0
      ],
      "name": "Rahin Wahedi"
    },
    {
      "affs": [
        0
      ],
      "name": "Arso Zahir-Akkra"
    },
    {
      "affs": [
        0,
        2,
        5
      ],
      "name": "Nele Gessler",
      "orcid": "0000-0001-5626-7749"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7v4jpwv14z0t2.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15208010",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13705792/?tool=EBI",
  "id": "7v4jpwv14z0t2",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/20/8010",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2705|Atrial Fibrillation Management and Outcomes"
    ]
  ],
  "openalex": "W7222114287",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13705792/pdf/?tool=EBI",
  "pmcid": "PMC13705792",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/7v4jpwv14z0t2.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:00Z",
      "native_id": "10.3390/jcm15208010",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/20/8010"
    },
    {
      "first_seen": "2026-10-30T12:21:40Z",
      "native_id": "PMC:PMC13705792",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13705792"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Atrial Fibrillation Management and Outcomes",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Repeat Ablation for Persistent Atrial Fibrillation: CFA/DOA-Guided Substrate Ablation Versus Re-PVI Alone in the Prematurely Terminated Randomized AF-CAM Trial",
  "title_text": "Repeat Ablation for Persistent Atrial Fibrillation: CFA/DOA-Guided Substrate Ablation Versus Re-PVI Alone in the Prematurely Terminated Randomized AF-CAM Trial",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:40Z",
  "url": "https://research.draconitic.com/paper/7v4jpwv14z0t2",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}