Abstract:Aim To explore the impact of ablation termination on the maintenance of sinus rhythm in long-standing persistent atrial fibrillation (LSPAF) by “Stepwise” ablation strategy. Methods This study involved 260 LSPAF patients who underwent “Stepwise” ablation strategy and clinical characteristics were collected. According to the ablation procedure, the patients were divided into ablation termination group and cardioversion group. The prognostic value of conversion to atrial flutter (AFL) and ablation termination was analyzed using subgroup analysis, followed up for 1 year to explore their impact on prognosis. Results Overall, 103 (39.6%) cases of LSPAF were terminated by ablation. Compared to the cardioversion group, the courses of atrial fibrillation and left atrial diameter were lower in the ablation termination group (all P＜0.05). At 1 year of follow-up, 45 (17.3%) patients had experienced recurrence, with no statistical difference in the proportion of recurrence between the two groups (all P＞0.05). Compared to preoperative, left atrial diameter was significantly lower after 1 year regardless of recurrence. In subgroup analysis, conversion to AFL and ablation termination was associated with the maintenance of long-term sinus rhythm (all P＜0.05). On multivariable Cox regression, the courses of atrial fibrillation, body mass index, left atrial diameter and fasting blood glucose were independent risk factors for recurrence. Conclusions 39.6% of LSPAF recovered sinus rhythm during the “Stepwise” ablation process, but there was no correlation with long-term sinus rhythm maintenance. Termination of ablation after conversion to AFL during ablation has a predictive effect on the maintenance of long-term sinus rhythm.
