Ensuring long-term arrhythmia freedom: what are the options for long-standing persistent atrial fibrillation?

CA remains the most effective rhythm-control strategy for LSPAF, but durable arrhythmia-free survival often requires repeat or hybrid procedures. Hybrid ablation should be considered, particularly in patients with advanced atrial remodeling. Emerging technologies, including PFA, offer the potential for improved outcomes. Future progress will depend on dedicated LSPAF trials with standardized endpoints, long-term follow-up, and broader patient representation to refine selection, optimize lesion sets, and establish the role of next-generation technologies.