Temporary Restoration of Sinus Rhythm Improves Outcomes of Catheter Ablation for Longstanding Persistent Atrial Fibrillation.

BACKGROUND

Long-standing persistent atrial fibrillation (LSPAF) is associated with adverse atrial structural and electrical remodeling, limiting the success of catheter ablation (CA).

OBJECTIVE

To determine whether temporary restoration of sinus rhythm (TRSR) can improve the single procedure efficacy of CA in patients with LSPAF.

METHODS

Patients with LSPAF undergoing their first CA between 2016 and 2022 were included. TRSR was attempted using cardioversion, with or without antiarrhythmic drugs (AAD), no later than 6 months before CA. The ablation strategy included pulmonary vein isolation (PVI), non-PV trigger ablation, and linear lesions for organized atrial tachyarrhythmias (OAT). The primary study outcome was freedom from atrial arrhythmias (AA: AF and/or OAT) on/off AAD at 12 months, and the secondary outcome was freedom from AA off AAD at 12 months.

RESULTS

One hundred eighty patients (median age 66 years, 24% female) were included. TRSR was attempted in 67 (37%) patients, and 17 (25%) of these presented in SR at the time of CA. Patients undergoing TRSR had more comorbidities (CHA2DS2-VASc score 3.1 vs. 2.7, p = 0.012) than those who did not. The primary and secondary outcomes were significantly better in the TRSR than the no TRSR group: AA-free survival (73% vs. 51%, p = 0.004) and AA-free survival off AAD (69% vs. 45%, p = 0.002). The primary outcome was better in the TRSR group, whether the presenting rhythm at CA was SR or AF (75% and 72%, respectively).

CONCLUSIONS

TRSR within 6 months of CA was associated with improved arrhythmia-free survival in LSPAF patients undergoing CA regardless of the presenting rhythm at ablation.