Are the site and mode of termination matters of prime importance in catheter ablation of persistent atrial fibrillation?

Role of AF Termination: Is There Any Difference Between Direct to Sinus Rhythm Versus Via Atrial Tachycardia? During catheter ablation of persistent atrial fibrillation (AF), the arrhythmia often organizes into a regular atrial tachyarrhythmia (AT) or directly terminates to sinus rhythm (SR). The termination of AF during ablation may be associated with higher long-term maintenance of SR, and has been proposed as an endpoint;1–4 however, there are also conflicting results5–7 and the effect of regular rhythms occurring during ablation on the clinical outcome is as yet unclear. AF termination cannot be achieved in all patients using current techniques. Some patients without AF termination with ablation do well clinically without arrhythmia recurrence and some patients with AF termination develop later recurrence of AT and/or AF. AF termination in patients with persistent AF can be achieved usually at the cost of extensive ablation, procedural risks, longer procedural and ablation times, and increased risk of post-ablation AT. Recently, I found increasing evidence that AF termination during catheter ablation is associated with a better clinical outcome, especially in patients with longstanding persistent AF. However, it is currently unclear how to identify those who will not terminate with ablation and those who do not have any potential to restore SR or who will not terminate with ablation, but ultimately do well clinically.