Impact of Aggressive Strategies for Early Recurrence After Atrial Fibrillation Ablation: A Retrospective Cohort Study

BACKGROUND: Suppressing atrial remodeling by reducing atrial fibrillation (AF) burden during the blanking period (BP) after AF ablation may lead to subsequent suppression of AF recurrence. However, the management of early recurrences (ERs) remains controversial. Herein, we examined the impact of aggressive strategies to restore and maintain sinus rhythm following AF ablation recurrence. METHODS: This retrospective cohort study initially included 681 consecutive patients who underwent an initial radiofrequency catheter ablation (RFCA) for AF at two centers; 151 patients with ERs of atrial tachyarrhythmias within 3 months post-RFCA were included in the final analysis. Participants were divided into two groups based on the treatment received: Group A, aggressive strategy (n = 112, paroxysmal: 49) and Group B, conservative strategy (n = 39, paroxysmal: 14). Baseline characteristics, clinical parameters, and recurrence rates 12 months after ablation (12m) were compared between groups. Both groups were stratified by AF type and similarly assessed. RESULTS: A significant difference was observed in the 12m recurrence-free rate between the groups (Group A: 82/112 [73.2%] vs. Group B: 21/39 [53.9%]; p = 0.016). The aggressive strategy was associated with a lower risk of 12m recurrence (adjusted hazard ratio, 0.24; 95% confidence interval, 0.08-0.74; p = 0.013). Among patients with paroxysmal AF (PAF), no difference was observed (Group A: 35/49 [71.4%] vs. Group B: 9/13 [69.2%]; p = 0.887); however, in those with non-PAF, the 12m recurrence-free rate was higher in Group A than in Group B (47/63 [74.6%] vs. 12/26 [46.2%]; p = 0.004). CONCLUSIONS: Aggressive strategies for ERs can reduce subsequent recurrences following AF ablation, especially in patients with non-PAF.