ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2026
Management of recurrent atrial fibrillation after catheter ablation: 5-year outcomes of repeat catheter ablation vs. antiarrhythmic therapy.
Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimsRecurrence of symptomatic atrial fibrillation (AF) after catheter ablation (CA) is not uncommon. However, real-world long-term data on clinical outcomes of rhythm control strategies in patients with recurrent AF after CA remain limited. METHODS AND
resultsUsing the TriNetX database, we identified adult patients (≥18 years) with recurrent AF after index CA. A 3-month blanking period was applied, during which no rhythm-control therapy was received. Patients were classified into two groups: repeat CA or initiation of antiarrhythmic drug (AAD) therapy. Propensity score matching (PSM) was performed to balance baseline characteristics. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated. Outcomes included all-cause mortality, all-cause hospitalization, heart failure (HF) exacerbation, ischaemic stroke, and major bleeding over 5 years. Among 4056 patients with recurrent AF post-CA, 17.2% underwent repeat CA. After PSM, 697 patients in the repeat CA group (mean age 68.9 ± 9.6 years; 35.7% female) and 697 in the AAD group (mean age 68.4 ± 10.0 years; 37.6% female) were analysed. Repeat CA was associated with lower all-cause mortality (3.3% vs 8.2%; HR 0.44; 95% CI, 0.27-0.72; P < 0.01), all-cause hospitalization (42.8% vs 56.4%; HR 0.71; 95% CI, 0.61-0.82; P < 0.01) and HF exacerbation (12.5% vs 24.8%; HR 0.50; 95% CI, 0.39-0.64; P < 0.01). No differences were observed in ischaemic stroke (5.3% vs 4.7%; HR 1.22; 95% CI, 0.77-1.96; P = 0.40) or major bleeding (4.6% vs 6.2%; HR 0.82; 95% CI, 0.52-1.29; P = 0.39).
conclusionRepeat CA was associated with lower mortality, hospitalization, and HF exacerbation over 5 years.
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