Background: Atrial fibrillation (AF) catheter ablation is a cornerstone rhythm-control intervention in symptomatic patients. Despite technological improvements, recurrence remains a critical determinant of long-term success, particularly in persistent AF. This study aimed to evaluate the 2-year clinical outcomes of high-power radiofrequency (RF) ablation performed in a high-volume single center and to identify predictors of AF recurrence in patients undergoing catheter ablation.

Methods: This retrospective observational study included 480 consecutive adults who underwent RF catheter ablation for AF between January 2021 and December 2024. The patients were categorized based on AF recurrence, defined as >30-second episodes detected during 48- to 72-hour Holter at 6, 12, 24, and 36 months.

Results: The cohort had a mean age of 59.8 ± 11.5 years, 56.3% were male, and 55.2% had persistent AF. The overall recurrence rate was 14.5% over an average follow-up duration
of 23.8 ± 9.2 months. The recurrence rate was 9.2% in paroxysmal AF and 20% in persistent AF. The left atrial diameter was significantly larger in recurrence-positive patients (43.1 ± 6.5 mm vs 41.4 ± 5.5 mm, P = .023). Additionally, mitral regurgitation (MR) was more prevalent in the recurrence-positive group, particularly in patients with ≥grade 3 MR (18.6% vs. 6.4%, P = .004). Independent predictors of recurrence were symptom duration (odds ratio [OR] = 1.01, P = .006, 95% CI: 1.00-1.02) and prior direct current cardioversion (OR = 3.12, P < .001, 95% CI: 2.34-4.10). The complication rate was 2.0%.

Conclusion: High-power RF ablation in an experienced center resulted in high sinus rhythm maintenance and low recurrence at 2 years. Individualized treatment strategies may have contributed to the low recurrence rates.