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Sinus rhythm duration after direct current cardioversion for persistent atrial fibrillation and long-term outcomes

Pok-Tin Tang1,2, Alexandre Almorad3, Giampaolo Vetta3

  • 1Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

Heart (British Cardiac Society)
|June 9, 2026
PubMed

Insights

Shorter sinus rhythm (SR) duration after direct current cardioversion (DCCV) before catheter ablation (CA) for persistent atrial fibrillation (PsAF) did not predict long-term AF recurrence. However, shorter SR duration was linked to arrhythmias during the post-CA blanking period.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Research

Background:

  • Persistent atrial fibrillation (PsAF) patients undergoing catheter ablation (CA) often experience high rates of recurrence.
  • Direct current cardioversion (DCCV) is frequently used before CA, but its effectiveness in maintaining sinus rhythm (SR) varies.

Purpose of the Study:

  • To investigate the association between shorter SR duration post-DCCV and the recurrence of atrial fibrillation (AF) after subsequent CA.

Main Methods:

  • International multicentre retrospective study of 938 patients undergoing first-time CA for PsAF with prior DCCV (2015-2024).
  • Patients categorized by post-DCCV SR duration: <7 days, 7-31 days, and >31 days.
  • Primary outcome: freedom from atrial arrhythmia post-CA (after 56-day blanking period).

Main Results:

  • No significant difference in long-term freedom from atrial arrhythmia among groups (log-rank p=0.10).
  • No association found between post-DCCV SR duration and time to first atrial arrhythmia recurrence (HR 1.00, p=0.07).
  • Significantly more blanking period arrhythmias in patients with <7 and 7-31 days SR duration compared to >31 days (pairwise p<0.001).

Conclusions:

  • Shorter SR duration post-DCCV is linked to blanking period arrhythmias but not long-term AF recurrence after CA for PsAF.
  • Findings may aid clinicians in assessing CA suitability and predicting long-term success.
Abstract

Keywords:
Ablation TechniquesArrhythmias, CardiacAtrial FibrillationCatheter AblationTreatment Outcome

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