EXPORT Randomized Trial

"1. Circumferential PVI is performed in all patients.~2. After PVI, isoproterenol is infused starting at 5 μg/min, increased every 3-5 min to 10 and 20 μg/min (max 30 μg/min) to reach 85% of predicted heart rate for ≥10 min.~ 2-1) If AF persists, internal cardioversion (5-30 J) is performed using catheters in the right atrium and coronary sinus.~ 2-2) If sinus rhythm is present, a 15-beat drive train (10 mA, 2 ms) is delivered at 250 ms, shortened by 10 ms to 180 ms or until capture fails, up to three times, to induce AF or AT. Isoproterenol continues for 2 min. If arrhythmia occurs, cardioversion is repeated.~3. After cardioversion, isoproterenol is stopped and the patient is observed for 10 min.~4. Sustained or reproducible arrhythmias are defined as non-PV triggers.~5. These are localized with activation mapping, P-wave analysis, and high-density mapping.~6. Ablation is performed with the same catheter.~7. Reassessment is done with the same protocol."

"1. Circumferential pulmonary vein isolation (PVI) is performed in all patients.~2. After PVI, a waiting period of at least 20 minutes is observed, followed by reassessment of pulmonary vein isolation before concluding the procedure.~3. Additional linear ablation or CFAE ablation not specified in the study protocol should be avoided whenever possible.~4. In cases where typical atrial flutter has been documented prior to the procedure or is induced during the procedure, cavo-tricuspid isthmus (CTI) ablation is performed. At the operator's discretion, CTI ablation may also be permitted even in patients without a prior history or inducibility.~5. If atypical atrial flutter involving these pathways is induced during the procedure, additional linear ablation (e.g., roof line, posterior-inferior line, left lateral isthmus, or anterior line) may be performed."