Intraprocedural atrial flutter transition predicts arrhythmia-free survival after “2C3L Plus” ablation for long-standing persistent atrial fibrillation

Background: Long-standing persistent atrial fibrillation (LSPAF) remains a challenge of catheter ablation. The efficiency and optimal procedural endpoints of "2C3L plus" approach-a strategy combining pulmonary vein isolation (PVI) with linear and complex fractionated atrial electrogram (CFAEs) ablation-is unclear. Methods: radiofrequency catheter ablation between January 2020 and January 2022. All patients received a standardized "2C3L plus" strategy. The primary endpoint was freedom from any documented atrial tachyarrhythmia lasting >30 s, off antiarrhythmic drugs, at 1-year follow-up. Predictors of recurrence were analyzed using multivariable Cox regression analysis. Results: = 0.014). Conclusion: In patients with LSPAF undergoing extensive "2C3L Plus" substrate ablation, the intraprocedural organization of AF-AFL-SR, rather than AF termination itself, emerged as a powerful independent predictor of 1-year arrhythmia-free survival, suggesting its value as a more meaningful prognostic endpoint.