{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T05:02:02Z","timestamp":1777006922226,"version":"3.51.4"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Long-standing persistent atrial fibrillation (LSPAF) remains a challenge of catheter ablation. The efficiency and optimal procedural endpoints of \u201c2C3L plus\u201d approach\u2014a strategy combining pulmonary vein isolation (PVI) with linear and complex fractionated atrial electrogram (CFAEs) ablation\u2014is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This single-center, retrospective cohort study included 260 consecutive patients with LSPAF (defined as continuous AF lasting\u2009&amp;gt;\u200912 months) who underwent\n                      <jats:italic>de novo<\/jats:italic>\n                      radiofrequency catheter ablation between January 2020 and January 2022. All patients received a standardized \u201c2C3L plus\u201d strategy. The primary endpoint was freedom from any documented atrial tachyarrhythmia lasting &amp;gt;30\u2005s, off antiarrhythmic drugs, at 1-year follow-up. Predictors of recurrence were analyzed using multivariable Cox regression analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Intraprocedural atrial fibrillation (AF) termination was achieved in 103 of 260 (39.6%) patients and 90 (34.6%) patients converted to atrial flutter (AFL) during ablation. Acute termination of AF directly to sinus rhythm (SR) was not associated with a lower risk of recurrence (adjusted HR: 0.765, 95% CI: 0.410\u20131.428,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.400). However, intraprocedural conversion from AF to AFL was associated with significantly reduced recurrence risk (Uni: HR: 0.319, 95% CI: 0.142\u20130.714,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.005; adjusted HR: 0.306, 95% CI: 0.133\u20130.704,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.005). Further analysis revealed that the sequential intraprocedural conversion of AF-AFL-SR during ablation was a strong and independent predictor of arrhythmia-free survival (Uni: HR: 0.275, 95% CI: 0.108\u20130.696,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.006; adjusted HR: 0.305, 95% CI: 0.119\u20130.784,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.014).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients with LSPAF undergoing extensive \u201c2C3L Plus\u201d 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1781094","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T04:29:56Z","timestamp":1777004996000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraprocedural atrial flutter transition predicts arrhythmia-free survival after \u201c2C3L Plus\u201d ablation for long-standing persistent atrial fibrillation"],"prefix":"10.3389","volume":"13","author":[{"given":"Tong","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kangning","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deyong","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"ii22","DOI":"10.1093\/europace\/euab257","article-title":"Atrial fibrillation progression and the importance of early treatment for improving clinical 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