Key result
Post-DCCV sinus rhythm duration shows no association with atrial arrhythmia recurrence after subsequent catheter ablation.
Why the study?
Patients undergoing catheter ablation for persistent AF have high recurrence rates, and it was unknown whether shorter sinus rhythm duration after prior DCCV is associated with post-ablation AF recurrence.
Does shorter sinus rhythm duration after direct current cardioversion predict atrial arrhythmia recurrence after subsequent catheter ablation in patients with persistent atrial fibrillation?
Cohort (n=938)
Yes
Does shorter sinus rhythm duration after direct current cardioversion predict atrial arrhythmia recurrence after subsequent catheter ablation in patients with persistent atrial fibrillation?
Hazard Ratio: 1 (95% CI 1–1.01)
p-value: p=0.07
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Shorter sinus rhythm duration after direct current cardioversion is associated with blanking period arrhythmias but does not predict long-term atrial fibrillation recurrence after subsequent catheter ablation.
Background Patients undergoing catheter ablation (CA) for persistent atrial fibrillation (PsAF) experience high rates of AF recurrence. Direct current cardioversion (DCCV) is often performed prior to CA, with variable post-DCCV duration of sinus rhythm (SR). Objective We aimed to determine whether shorter SR duration after DCCV is associated with AF recurrence after subsequent CA. Methods We performed an international multicentre retrospective study of patients undergoing first-time CA for PsAF between 2015 and 2024 with a prior DCCV. SR duration after the last DCCV preceding CA was recorded. The primary outcome was freedom from atrial arrhythmia after CA (after a 56-day postablation blanking period). Results 938 patients undergoing first-time CA for PsAF were identified from six centres and categorised by post-DCCV SR duration: <7 days (group 1, n=212); 7–31 days (group 2, n=236); and >31 days (group 3, n=490). Over median post-CA follow-up of 511 days, 512 patients (55%) experienced atrial arrhythmia recurrence. There was no significant between-group difference in freedom from atrial arrhythmia (log-rank p=0.10). When analysed as a continuous variable in a Cox regression model, there was no association between post-DCCV SR duration and time to first recurrence of atrial arrhythmia (HR per 10-day increment 1.00, 95% CI 1.00 to 1.01, p=0.07). In secondary analyses, there were significantly more blanking period arrhythmias in groups 1 and 2 compared with group 3 (both pairwise p<0.001), and presentation for CA in persistent atrial arrhythmia was associated with a time-dependent increased risk of atrial arrhythmia recurrence compared with presentation in SR. Conclusion In this large multicentre cohort, shorter duration of SR after DCCV was associated with blanking period arrhythmia after subsequent CA, but we did not find evidence of an association with long-term AF recurrence. Clinicians should consider these findings when making decisions regarding suitability for CA or predicting long-term CA success.
Tang et al. (2026) conducted a cohort in Persistent atrial fibrillation (n=938). Shorter duration of sinus rhythm after direct current cardioversion vs. Longer duration of sinus rhythm was evaluated on Freedom from atrial arrhythmia after catheter ablation (after a 56-day postablation blanking period) (HR 1.00, 95% CI 1.00 to 1.01, p=0.07). Post-DCCV sinus rhythm duration was not associated with time to first recurrence of atrial arrhythmia after subsequent catheter ablation (HR per 10-day increment 1.00; 95% CI 1.00-1.01; p=0.07).
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