Background: Little is known about the long-term outcome and recurrent form after catheter ablation of atrial fibrillation (AF) in patients with a duration of long-standing persistent AF of ≥5 years. Methods: Two hundred thirty-six patients with persistent AF (193 men; age, 61.5±10.7 years) were enrolled, and were classified by the duration of AF: AF duration of <1 year (group A, n=99), between 1 to 5 years (group B, n=101), and ≥5 years (group C, n=36). The long-term recurrence rate and recurrent form were compared among the groups. Results: During a median follow-up of 3.7 years, the recurrence rate was significantly worse in group C after the index, and multiple procedures (Log-Rank, both for a P<0.001 in comparison with group A). In the multivariate analysis, the duration was the independent predictor of an arrhythmia recurrence (HR, 1.206; 95%CI, 1.053 to 1.381; P=0.007). Recurrent AF became permanent in 8 patients (3.4%), which was not associated with a difference in the groups (Log-rank, P=0.055), while antiarrhythmic drugs (AADs) were continued in 70% of the recurrent patients. Conclusions: Despite the high AF recurrence rate in the patients with an AF duration of ≥5 years, the majority of the patients with recurrence who continued on AADs had a paroxysmal form of AF. Catheter ablation and concomitant AADs may be effective in in reducing the AF burden in such patients with an advanced AF disease stage.