What are the effective rhythm-control strategies for ensuring long-term arrhythmia freedom in patients with long-standing persistent atrial fibrillation?
Catheter ablation is the primary rhythm-control strategy for long-standing persistent AF, with hybrid ablation and pulsed field ablation offering potential for improved long-term outcomes.
CA remains the most effective rhythm-control strategy for LSPAF, but durable arrhythmia-free survival often requires repeat or hybrid procedures. Hybrid ablation should be considered, particularly in patients with advanced atrial remodeling. Emerging technologies, including PFA, offer the potential for improved outcomes. Future progress will depend on dedicated LSPAF trials with standardized endpoints, long-term follow-up, and broader patient representation to refine selection, optimize lesion sets, and establish the role of next-generation technologies.
Kotoulas et al. (Wed,) studied this question.