{
  "abstract": "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.",
  "authors": [
    {
      "affiliations": [
        "Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK",
        "Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK"
      ],
      "name": "Pok-Tin Tang"
    },
    {
      "affiliations": [
        "Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium"
      ],
      "name": "Alexandre Almorad"
    },
    {
      "affiliations": [
        "Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium"
      ],
      "name": "Giampaolo Vetta"
    },
    {
      "affiliations": [
        "Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Jia H Chan"
    },
    {
      "affiliations": [
        "University of Oxford Medical School, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Jonathan Hampshire"
    },
    {
      "affiliations": [
        "University of Oxford Medical School, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Kate Eastwick-Jones"
    },
    {
      "affiliations": [
        "University of Oxford Medical School, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Holden Eaton"
    },
    {
      "affiliations": [
        "Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Calum A Robertson"
    },
    {
      "affiliations": [
        "Department of Cardiology, Queen Alexandra Hospital, Cosham, UK"
      ],
      "name": "Rebecca L M Griffiths"
    },
    {
      "affiliations": [
        "Department of Cardiology, Queen Alexandra Hospital, Cosham, UK"
      ],
      "name": "Amanda Hurst"
    },
    {
      "affiliations": [
        "Department of Cardiology, Queen Alexandra Hospital, Cosham, UK"
      ],
      "name": "Milena Leo"
    },
    {
      "affiliations": [
        "Department of Cardiology, Queen Alexandra Hospital, Cosham, UK"
      ],
      "name": "Senthil Kirubakaran"
    },
    {
      "affiliations": [
        "Yorkshire Heart Centre, Leeds General Infirmary,The Leeds Teaching Hospitals NHS Trust, Leeds, UK"
      ],
      "name": "Sacchin Arockiam"
    },
    {
      "affiliations": [
        "Yorkshire Heart Centre, Leeds General Infirmary,The Leeds Teaching Hospitals NHS Trust, Leeds, UK"
      ],
      "name": "Matthew Aldred"
    },
    {
      "affiliations": [
        "Yorkshire Heart Centre, Leeds General Infirmary,The Leeds Teaching Hospitals NHS Trust, Leeds, UK"
      ],
      "name": "Ben Mercer"
    },
    {
      "affiliations": [
        "Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, UK"
      ],
      "name": "Nikhil Ahluwalia"
    },
    {
      "affiliations": [
        "Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, UK"
      ],
      "name": "Rangeena Assadi"
    },
    {
      "affiliations": [
        "Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, UK"
      ],
      "name": "Ross J Hunter"
    },
    {
      "affiliations": [
        "Heart Rhythm Centre, Cardiology, Royal Brompton and Harefield NHS Foundation Trust,Guy’s and St Thomas’ NHS Foundation Trust, Harefield, UK"
      ],
      "name": "Haseeb Valli"
    },
    {
      "affiliations": [
        "Heart Rhythm Centre, Cardiology, Royal Brompton and Harefield NHS Foundation Trust,Guy’s and St Thomas’ NHS Foundation Trust, Harefield, UK"
      ],
      "name": "Ken Ali"
    },
    {
      "affiliations": [
        "Heart Rhythm Centre, Cardiology, Royal Brompton and Harefield NHS Foundation Trust,Guy’s and St Thomas’ NHS Foundation Trust, Harefield, UK"
      ],
      "name": "Shouvik Haldar"
    },
    {
      "affiliations": [
        "Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK",
        "Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK"
      ],
      "name": "Timothy R Betts"
    },
    {
      "affiliations": [
        "Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Michala Pedersen"
    },
    {
      "affiliations": [
        "Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Kim Rajappan"
    },
    {
      "affiliations": [
        "Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Yaver Bashir"
    },
    {
      "affiliations": [
        "Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK",
        "Nuffield Department of Population Health, University of Oxford, Oxford, UK"
      ],
      "name": "Rohan S Wijesurendra"
    },
    {
      "affiliations": [
        "Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Matthew R Ginks"
    }
  ],
  "title": "Sinus rhythm duration after direct current cardioversion for persistent atrial fibrillation and long-term outcomes after subsequent catheter ablation",
  "uid": "1fcabefa-f865-5770-a04c-b97fb417870f"
}