Repeat Catheter Ablation after Very Late Recurrence of Atrial Fibrillation after Pulmonary Vein Isolation.

Background and Aims: Atrial fibrillation (AF) recurs in about one third of patients after catheter ablation (CA), mostly in the first year. Little is known about the electrophysiological findings and the effect of re-ablation in very late AF recurrences after more than one year. The aim of this study was to determine the characteristics and outcomes of the first repeat CA after very late recurrence of AF after index CA.
Methods: We analysed patients from a prospective Swiss registry that underwent a first repeat ablation procedure. Patients were stratified depending on the time to recurrence after index procedure: early recurrence (ER) for recurrences within the first year and late recurrence (LR) if the recurrence was later. The primary endpoint was freedom from AF in the first year after repeat ablation.
Results: Out of 1864 patients included in the registry, 426 patients undergoing a repeat ablation were included in the analysis (28% female, age 63 ± 9.8 years, 46% persistent AF). 291 patients (68%) were stratified in the ER group and 135 patients (32%) in the LR group. Pulmonary vein reconnections were a common finding in both groups, with 93% in the ER group compared to 86% in the LR group (p = 0.052). In the LR group, 40 of 135 patients (30%) had a recurrence of AF compared to 90 of 291 patients (31%) in the ER group (log rank p = 0.72).
Conclusion: There was no association between the time to recurrence of AF after initial catheter ablation and the characteristics and outcomes of the repeat procedure.
(© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)