Radiofrequency ablation for long-standing persistent AF shows intraprocedural conversion patterns linked to 1-year outcomes.
This retrospective cohort study included 260 consecutive patients with long-standing persistent atrial fibrillation (AF lasting >12 months) at a single center. All underwent de novo radiofrequency catheter ablation using a standardized '2C3L plus' strategy, combining pulmonary vein isolation with linear and complex fractionated atrial electrogram ablation. The primary outcome was freedom from any documented atrial tachyarrhythmia lasting >30 seconds, off antiarrhythmic drugs, at 1-year follow-up.
Intraprocedural AF termination was achieved in 103 of 260 patients. Intraprocedural conversion to atrial flutter (AFL) was achieved in 90 of 260 patients and was associated with a reduced recurrence risk (adjusted HR: 0.306; 95% CI: 0.133–0.704, P = 0.005). Sequential intraprocedural conversion of AF-AFL-SR was a strong and independent predictor of arrhythmia-free survival (adjusted HR: 0.305; 95% CI: 0.119–0.784, P = 0.014).
In contrast, acute termination of AF directly to sinus rhythm was not associated with a lower risk of recurrence (adjusted HR: 0.765; 95% CI: 0.410–1.428, P = 0.400). Safety data, including adverse events, serious adverse events, discontinuations, and tolerability, were not reported.
Key limitations include the retrospective, single-center design and lack of a comparator group. The findings suggest that intraprocedural organization of AF-AFL-SR may be a meaningful prognostic endpoint, but causal inferences cannot be drawn. Clinicians should interpret these results as hypothesis-generating for procedural planning in persistent AF.
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