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

Abstract

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.