Statistical Analysis
Continuous variables were expressed as median and interquartile ranges and compared using Mann-Whitney U test. Patients were compared based on recurrence status (yes or no recurrence) and AF type, distinguishing between those with paroxysmal AF and persistent AF. Categorical variables were expressed as counts and percentages and were compared using the Chi-square test or exact Fisher test, as warranted.
Comparative effectiveness of ablation strategies was evaluated with multivariable Cox proportional hazards models. Patients were followed from the index date of the first repeat AF ablation. Models were adjusted for age, sex, BMI, AF pattern (e.g. paroxysmal, persistent), diabetes, coronary artery disease, and hypertension. Cox models compared individual ablation strategies, number of ablation strategies performed, and presence of persistent AF. Kaplan-Meier estimates were utilized to generate time-to-first-arrhythmia recurrence curves, which were subsequently compared employing the log-rank test. In our models, we analyzed the effects of all strategies, irrespective of whether they were used alone or in combination with others. Interaction analyses between the primary ablative strategies were conducted to ensure the comprehensive evaluation of their impact. Results are presented as hazard ratios (HR) along with their corresponding 95% confidence intervals (CI). Effects estimates with 95% CI were used to determine statistical significance together with P value < 0.05. Statistical analyses were conducted using STATA version 18 (StataCorp LLC, College Station, TX, USA).