Impact of Ablation Targeting Atrial Drivers and Fragmented Potentials on Long-Standing Persistent Atrial Fibrillation: A Retrospective Study

Abstract

Background

Long-standing persistent atrial fibrillation (AF) often shows resistance to pulmonary vein isolation (PVI) alone. This study aimed to compare the outcomes of catheter ablation targeting electrophysiological substrates versus conventional PVI in patients with long-standing persistent AF.

Methods

This retrospective study included 105 patients with long-standing persistent AF who underwent initial catheter ablation between June 2021 and June 2023. After propensity score matching (n = 38 each), we compared conventional PVI (conventional group) with additional ablation targeting AF drivers and fragmented potentials (driver and fragmented potentials group). The primary endpoint was AF recurrence lasting > 30 s occurring ≥ 3 months post-ablation.

Results

Procedure times were longer in the driver and fragmented potentials group (166.1 ± 35.9 vs. 140.7 ± 50.4 min, p = 0.01). Higher rotational activity was observed in the left atrial appendage and bottom regions in this group. Over a mean follow-up of 383.5 ± 21.1 days, AF recurrence was numerically lower in the driver and fragmented potentials group (21.1% vs. 36.8%, p = 0.13). Post-ablation premature atrial contractions were significantly fewer in the driver and fragmented potentials group (p < 0.01). Multivariate analysis identified fragmented potentials and driver activity in the bottom region as independent predictors of AF recurrence (p = 0.02; 95% CI: 1.08–3.12).

Conclusions

Ablation targeting atrial drivers and fragmented potentials demonstrated a trend toward improved clinical outcomes compared to conventional PVI alone, with reduced AF recurrence and PAC burden. The bottom region of the left atrium appears to be a significant therapeutic target for improving long-term success in long-standing persistent AF ablation.