Management of Recurrent Atrial Fibrillation After Catheter Ablation: Five-Year Outcomes of Repeat Ablation Versus Initiation of Antiarrhythmic Therapy

Document Type

Conference Proceeding

Publication Date

4-7-2026

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND Recurrence of symptomatic atrial fibrillation (AF) af-ter catheter ablation (CA) is not uncommon. However, contemporary real-world long-term data on clinical outcomes of rhythm control strategies in recurrent AF after CA remain limited. METHODS We used TriNetX to identify adults with recurrent AF after index CA. Patients were classified into two mutually exclusive groups based on their subsequent rhythm-control strategy: repeat ablation or initiation of antiarrhythmic drug (AAD). Five-year outcomes were all-cause mortality, all-cause hospitalization, heart failure (HF) exacerbation, ischemic stroke, and major bleeding (intracranial or gastrointestinal). RESULTS Among 4,010 patients with recurrent AF post-CA, 15.4%had repeat ablation. After propensity score matching, there were 617 patients in each group. Over five years, repeat ablation was associated with lower all-cause mortality (2.3% vs 5.8%, P=0.01), all-cause hospitalization (35.5% vs 50.6%, P< 0.01) and HF exacerbation (11.8% vs 20.9%, P< 0.01) than initiation of AAD. No significant differences were observed in ischemic stroke (5.3% vs 6.2%, P=0.99) or major bleeding (5.0% vs 4.7%, P=0.28).CONCLUSION In this five-year retrospective study, repeat ablation for recurrent AF post-CA was associated with lower mortality, hospitalization, and HF exacerbation, underscoring its potential long-term clinical benefits in this population.

Volume

87

Issue

13 Suppl

First Page

A51

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A52

DOI

10.1016/j.jacc.2026.02.133

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