Effect of Acute Termination of Atrial Fibrillation on the Outcome of Ablation of Persistent Atrial Fibrillation

Background: The success rates for ablation of persistent atrial fibrillation (PerAF) are lower than those for ablation of paroxysmal AF (PAF). We investigated whether a relation exists between the presence of sinus rhythm (SR) early in the procedure and the ablation outcome in patients with PerAF. Methods and Results: The study involved 46 patients with persistent AF (< 7 days duration; 7 women, 39 men, aged 60.8 ± 10.0 years; AF duration, 14 [5, 48] months) who underwent pulmonary vein isolation (PVI). Ablation outcomes were compared between patients who were in SR early during the procedure, because 1) SR was present at the start of the procedure (SR group), 2) AF was electrically cardioverted to SR before PVI (DC group), or 3) PVI was performed during AF (AF group). After a 3-month blank period, the incidence of freedom from AF after the single procedure was significantly higher in the SR group compared with that in the DC and AF groups (100%, 46% and 50%, respectively, P = 0.0110), during median follow-up periods of 15.5, 19.4, and 28.2 months, respectively. Conclusion: The presence of spontaneous SR before ablation for PerAF appears to be related to AF-free survival.