Duration of atrial fibrillation persistence: Implications for recurrence risk after catheter ablation and efficacy of additional substrate ablation
Related Experiment Video
Updated: Jul 4, 2025
Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology
Published on: May 26, 2015
Yasuharu Matsunaga-Lee1, Koichi Inoue2, Nobuaki Tanaka3
1Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan.
Insights
For patients with long-standing atrial fibrillation (AF) undergoing catheter ablation, AF persistence longer than 2.4 years is linked to higher recurrence. The PVI-plus strategy may be superior for these cases.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Catheter ablation is a common treatment for atrial fibrillation (AF).
- Optimal ablation strategies and duration of AF persistence predicting outcomes in long-standing AF (LsAF) remain unclear.
Purpose of the Study:
- To assess the impact of AF duration on outcomes after catheter ablation.
- To determine the optimal cutoff duration of AF persistence for predicting outcomes in LsAF.
Main Methods:
- Analysis of data from the EARNEST-PVI trial.
- Comparison of pulmonary vein isolation (PVI) alone versus PVI-plus strategies.
- Evaluation of arrhythmia-free survival in patients with persistent AF (PerAF) and LsAF, stratified by AF duration.
Main Results:
- The optimal cutoff for AF persistence was 2.4 years.
- LsAF between 1-2.4 years showed outcomes comparable to PerAF.
- LsAF >2.4 years demonstrated a significantly higher recurrence risk (HR 2.22) compared to PerAF.
- In LsAF >2.4 years, PVI-plus was superior to PVI-alone (HR 0.36).
Conclusions:
- AF duration exceeding 2.4 years is associated with poorer outcomes after catheter ablation.
- The PVI-plus strategy may offer improved efficacy for LsAF >2.4 years.
- Further research may refine ablation strategies based on AF persistence duration.
Background:
The optimal duration of atrial fibrillation (AF) persistence for predicting poor outcomes after catheter ablation of long-standing AF (LsAF) and the best ablation strategy for these patients remain unclear.
Objective:
We aimed to assess the impact of the duration of AF persistence on outcomes after catheter ablation of AF.
Methods:
We analyzed the Efficacy of Pulmonary Vein Isolation Alone in Patients with Persistent Atrial Fibrillation (EARNEST-PVI) trial data comparing pulmonary vein isolation (PVI) alone (PVI-alone) with additional linear ablation or defragmentation (PVI-plus) in persistent AF (PerAF). Patients who received catheter ablation by contact force-sensing catheter were enrolled in the study. In patients with LsAF, the optimal cutoff duration of AF persistence was evaluated. With use of the threshold, patients with LsAF were divided into 2 groups and compared with PerAF <1 year for arrhythmia-free survival after a 3-month blanking period.
Results:
The optimal cutoff duration was 2.4 years. Of 458 patients, arrhythmia-free survival rates for LsAF 1-2.4 years were comparable to those of PerAF (hazard ratio [HR], 1.01; 95% CI, 0.67-1.52). However, LsAF >2.4 years had a higher recurrence risk than PerAF (HR, 2.22; 95% CI, 1.42-3.47). In LsAF >2.4 years, the PVI-plus strategy showed advantages over the PVI-alone strategy (HR, 0.36; 95% CI, 0.14-0.89). However, the interaction effect between LsAF 1-2.4 years and LsAF >2.4 years did not reach statistical significance (P = .116).
Conclusion:
Whereas LsAF 1-2.4 years has similar outcomes to those of PerAF, LsAF >2.4 years was linked to higher arrhythmia recurrence risks. For LsAF >2.4 years, the PVI-plus strategy showed a potential to be superior to the PVI-alone strategy.
Related Concept Videos
01:28Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow...
01:24Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers
01:12Antiarrhythmic Drugs: Class III Agents as Potassium Channel Blockers