Efficacy of Radiofrequency Catheter Pulmonary Vein Isolation with Preoperative Electrical Cardioversion in Patients with Persistent Atrial Fibrillation

Atrial fibrillation (AF) is the most common form of cardiac arrhythmia in clinical practice treated with both pharmacological and surgical methods. Since the use of antiarrhythmic drugs does not always effectively control the heart rhythm and imposes a risk of developing proarrhythmias and conduction disturbances, radiofrequency ablation of the pulmonary vein ostia has become a recognized treatment for patients with symptomatic AF. Recurrences after catheter ablation (CA) in patients with persistent and long-standing persistent AF are significantly more common than in paroxysmal AF. In clinical practice, it is important to accurately predict the long-term outcomes of CA in patients with persistent AF to determine further treatment tactics. There is evidence that restoration of sinus rhythm before surgical treatment reduces the risk of recurrence in patients with persistent AF; however, these associations have not been adequately studied.In patients with persistent, especially long-standing persistent AF, the degree of arrhythmogenic atrial remodeling can vary widely. Predicting the effectiveness of CA and adjusting the extent of the procedure requires a detailed characterization of the arrhythmogenic substrate in the left atrium (LA), which can be achieved through detailed mapping of areas with fibrotic changes and low-amplitude activity. Therefore, the aim of this review is to summarize the reports about the impact of prior electrical cardioversion before CA in patients with AF on the long-term outcomes of the catheter-based treatment and a possibility of achieving structural and functional reverse LA remodeling. This review may be useful for practicing interventional arrhythmologists and cardiologists engaged in the surgical and medical treatment of patients with persistent AF.