Long-term outcomes of radiofrequency catheter ablation for patients with persistent atrial fibrillation lasting ≥ 3 years

Background: Radiofrequency catheter ablation (RFCA) for long-standing persistent atrial fibrillation (LSP-AF) remains challenging, especially in patients with very long atrial fibrillation (AF) duration. Objective: To evaluate the long-term outcomes of RFCA in patients with LSP-AF lasting ≥ 3 years, and to identify predictors for AF recurrence. Methods: This retrospective study included 151 patients with LSP-AF undergoing first-time RFCA. Procedure was performed with wide antral pulmonary vein isolation (PVI) based individualized ablation strategy, guided by ablation index (AI). Patients were followed up for ? 18 months, and recurrence predictors were determined. Results: Enrolled patients (mean persistent AF duration: 7.6 ± 5.2 years) had a mean age of 65.3 ± 9.2 years and the median left atrial diameter (LAD) was 45.0 (42.0-49.0) mm. PVI was achieved in all, followed by modified left posterior wall isolation (PWI) in 147 patients. Additional ablation after PWI was performed in 88 patients. During the 18-month follow-up, the overall success rate was 74.2%. Multivariate analysis identified AF duration (HR 1.078; 95% CI 1.020-1.139; P = 0.007), LAD (HR 1.069; 95% CI 1.010-1.132; P = 0.022), and pre-procedure CRP (HR 1.063; 95% CI 1.010-1.117; P = 0.018) as independent predictors of AF recurrence. Among patients with PVI and PWI, those without empirical additional ablation (EAA) had a lower but not statistically significant recurrence rate (18.6%) than those with EAA (31.8%, P = 0.076). Conclusion: Among LSP-AF patients, the long-term efficacy of AI-guided RFCA is acceptable, especially in selected patients. However, EAA after PVI and PWI may be unhelpful.