Catheter ablation is widely used to treat atrial fibrillation (AF), but uncertainty persists about whether outcomes differ between persistent and paroxysmal forms. A population-based cohort study published in EP Europace assessed outcomes in 10,788 patients undergoing de novo AF ablation in Ontario from 2012 to 2022. One-quarter of patients had persistent AF.

After applying inverse probability of treatment weighting to balance age, sex, and comorbidities, the composite outcome of all-cause mortality and hospitalization showed no significant difference between persistent and paroxysmal AF: 5.5% vs. 6.3% at 30 days (HR 1.15; 95% CI 0.94–1.40), 19.8% vs. 19.7% at 1 year (HR 1.00; 95% CI 0.90–1.11), and 34.1% vs. 35.4% at 3 years (HR 1.05; 95% CI 0.97–1.13). Outcomes for the individual components were also similar across time points.

The study concludes that comorbidities, rather than arrhythmia type, primarily drive long-term risk after ablation. These findings may reassure clinicians that persistent AF should not be considered a barrier when selecting patients for ablation.