Arrhythmia Recurrence and Rhythm Control Strategies After Catheter Ablation of Newly Diagnosed Atrial Fibrillation (JCEP April 2025)-Article: Arrhythmia Recurrence and Rhythm Control Strategies After Catheter Ablation of Newly Diagnosed Atrial Fibrillation

Article: Arrhythmia Recurrence and Rhythm Control Strategies After Catheter Ablation of Newly Diagnosed Atrial Fibrillation

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The ARRC-AF study examined rhythm-control strategies following catheter ablation in patients with newly diagnosed atrial fibrillation (AF) using the Optum Market Clarity Database. This large-scale study analyzed 2.43 million patients who underwent their first ablation for AF between 2007 and 2021. The study aimed to understand the role of repeat ablations and antiarrhythmic drugs (AADs) in managing arrhythmia recurrences after initial ablation.<br /><br />Results indicated that of the 23,323 patients who underwent an initial ablation, 16.6% required repeat ablations: 14.2% had a second ablation, 2.0% had a third, and 0.4% had four or more. Repeat ablations were associated with specific AF characteristics, notably the long-standing persistent AF phenotype, prior ablations, and patient comorbidities such as obstructive sleep apnea and coronary artery disease. Notably, antiarrhythmic drug use was common post-ablation, at 46.9%, peaking at 69.9% among patients with multiple repeat ablations.<br /><br />The study found that AF recurrence remains significant after an initial ablation, driving the continued use of repeat ablations and AADs in clinical practice. Moreover, factors such as a younger age, shorter duration between AF diagnosis and ablation, and existing comorbidities increased the likelihood of undergoing repeat procedures.<br /><br />Overall, the ARRC-AF study highlights the importance of a combined strategy of catheter ablation and medication in managing AF. These findings suggest that while catheter ablation is an effective initial option for rhythm control, ongoing management with both repeat ablation and AADs is crucial for many patients, aligning with real-world treatment practices evident in the study’s findings.

Keywords

ARRC-AF study

rhythm-control strategies

catheter ablation

atrial fibrillation

Optum Market Clarity Database

antiarrhythmic drugs

repeat ablations

arrhythmia recurrences

patient comorbidities

real-world treatment