Characteristics, trends, and outcomes of ablation for persistent atrial fibrillation: a Danish cohort study

Aims Catheter ablation (CA) is widely used for atrial fibrillation (AF), but pulmonary vein isolation (PVI) alone is less effective in persistent AF (peAF) than paroxysmal AF (PAF). Real-world data on patient selection, outcomes, and complications with PVI or PVI plus (≥1 additional line or CFAE/ganglionated plexi ablation) are limited. We examined characteristics, trends, recurrence, and complications in peAF ablations. Methods and results Patients with peAF undergoing first-time catheter ablation between 2010 and 2020 were identified from the Danish National Ablation Database. They were categorized by ablation strategy (PVI or PVI plus), and baseline characteristics and trends were assessed. AF recurrence was analysed using cumulative incidence at one and five years, and across procedural years. Major adverse cardiovascular events (MACE) and procedure-related complications were also examined. Among 4144 peAF patients, 3.417 received PVI and 727 PVI plus. Baseline characteristics were similar, except the PVI plus group had longer diagnosis-to-ablation-time (mean 5.67 years vs. 3.9 years, P < 0.001) and more severe atrial enlargement (14.8% vs. 9.8%, P < 0.001). AF recurrence was higher with PVI plus at one- and five-years (54% vs. 46%, 77% vs. 68%). Recurrence rates declined over time (2010–2013 vs. 2018–2020). PVI plus use decreased from 58% to 15%. MACE and complication rates were low and similar. Conclusion PVI plus was used less frequently over time and was associated with longer diagnosis-to-ablation times and larger left atria. We observed a proportional decline for both groups in AF recurrence across procedural years, and complication rates were low and similar.