Arrhythmias & electrophysiologyCohort study
Sinus rhythm duration after direct current cardioversion for persistent atrial fibrillation and long-term outcomes after subsequent catheter ablation
- international multicentre retrospective study
Authors' 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.
Study context
- Population
- Patients undergoing first-time catheter ablation (CA) for persistent atrial fibrillation (PsAF) between 2015 and 2024 with a prior direct current cardioversion (DCCV)patients undergoing first-time CA for PsAF from six centres
- Participants
- 938 patients
- Exposure
- post-DCCV sinus rhythm (SR) duration and AF recurrence after subsequent CA
- group 1n = 212
- group 2n = 236
- group 3n = 490
- Outcome
- freedom from atrial arrhythmia after CA (after a 56-day postablation blanking period)
- Follow-up
- Median post-CA 511 days
Main finding
As reported in the abstract
Hazard ratio
1.00
95% CI 1.00–1.01
P = 0.07
post-DCCV SR duration (per 10-day increment)
HR 1.00 (95% CI 1.00–1.01); P = 0.07
Per 10-day increment, as printed
- patients with atrial arrhythmia recurrence
- 512 patients (55%)
- no significant between-group difference in freedom from atrial arrhythmia
- log-rank p=0.10
Observational data: associations, not effects.
Further findings
blanking period arrhythmias
- significantly more blanking period arrhythmias in groups 1 and 2 compared with group 3
- both pairwise p<0.001
- secondary analyses
atrial arrhythmia recurrence by rhythm at presentation for CA
- presentation for CA in persistent atrial arrhythmia was associated with a time-dependent increased risk of atrial arrhythmia recurrence compared with presentation in SR
- secondary analyses
Original publication
Sinus rhythm duration after direct current cardioversion for persistent atrial fibrillation and long-term outcomes after subsequent catheter ablation. Heart. Published 9 June 2026. doi:10.1136/heartjnl-2025-327359
Summarised from the published abstract; every number is checked against it