Intraprocedural conversion from atrial fibrillation to atrial flutter during '2C3L Plus' ablation significantly reduced the risk of 1-year arrhythmia recurrence (adjusted HR 0.306).
Cohort (n=260)
No
Does intraprocedural conversion of AF to AFL to SR predict arrhythmia-free survival in patients with LSPAF undergoing '2C3L Plus' ablation?
Intraprocedural organization of AF to AFL to SR during extensive substrate ablation is a powerful independent predictor of 1-year arrhythmia-free survival in patients with long-standing persistent AF.
Effect estimate: HR 0.306 (95% CI 0.133-0.704)
p-value: p=0.005
Background Long-standing persistent atrial fibrillation (LSPAF) remains a challenge of catheter ablation. The efficiency and optimal procedural endpoints of “2C3L plus” approach—a strategy combining pulmonary vein isolation (PVI) with linear and complex fractionated atrial electrogram (CFAEs) ablation—is unclear. Methods This single-center, retrospective cohort study included 260 consecutive patients with LSPAF (defined as continuous AF lasting 12 months) who underwent de novo radiofrequency catheter ablation between January 2020 and January 2022. All patients received a standardized “2C3L plus” strategy. The primary endpoint was freedom from any documented atrial tachyarrhythmia lasting 30 s, off antiarrhythmic drugs, at 1-year follow-up. Predictors of recurrence were analyzed using multivariable Cox regression analysis. Results Intraprocedural atrial fibrillation (AF) termination was achieved in 103 of 260 (39.6%) patients and 90 (34.6%) patients converted to atrial flutter (AFL) during ablation. Acute termination of AF directly to sinus rhythm (SR) was not associated with a lower risk of recurrence (adjusted HR: 0.765, 95% CI: 0.410–1.428, P = 0.400). However, intraprocedural conversion from AF to AFL was associated with significantly reduced recurrence risk (Uni: HR: 0.319, 95% CI: 0.142–0.714, P = 0.005; adjusted HR: 0.306, 95% CI: 0.133–0.704, P = 0.005). Further analysis revealed that the sequential intraprocedural conversion of AF-AFL-SR during ablation was a strong and independent predictor of arrhythmia-free survival (Uni: HR: 0.275, 95% CI: 0.108–0.696, P = 0.006; adjusted HR: 0.305, 95% CI: 0.119–0.784, P = 0.014). Conclusion In patients with LSPAF undergoing extensive “2C3L Plus” substrate ablation, the intraprocedural organization of AF-AFL-SR, rather than AF termination itself, emerged as a powerful independent predictor of 1-year arrhythmia-free survival, suggesting its value as a more meaningful prognostic endpoint.
Liu et al. (Fri,) conducted a cohort in Long-standing persistent atrial fibrillation (n=260). Intraprocedural conversion to atrial flutter during '2C3L Plus' ablation vs. Direct conversion to sinus rhythm or cardioversion was evaluated on Freedom from any documented atrial tachyarrhythmia lasting >30 s, off antiarrhythmic drugs, at 1-year follow-up (HR 0.306, 95% CI 0.133-0.704, p=0.005). Intraprocedural conversion from atrial fibrillation to atrial flutter during '2C3L Plus' ablation significantly reduced the risk of 1-year arrhythmia recurrence (adjusted HR 0.306).