Background: Rhythm control in atrial fibrillation (AF) can be achieved with catheter ablation, but arrhythmia recurrences can require further interventions.
Objectives: The aim of this study was to characterize rhythm-control strategies after index ablation.
Methods: A total of 2,429,863 patients in Optum’s deidentified Market Clarity Data who underwent index ablation for newly diagnosed AF (2007-2021) were followed until disenrollment, death, or study end. Repeat ablations; AF, atrial flutter, or other tachycardias following index ablation; and antiarrhythmic drug (AAD) practices after ablation were examined.
Results: 23,323 patients underwent index ablation (median follow-up: 1,165 days); 3,862 (16.6%) had ≥2 ablations (2 ablations, 14.2%; 3 ablations, 2.0%; ≥4 ablations, 0.4%). In patients with repeated ablations, incident individual AF/AFL patient events (n=7907) averaged 2.0/patient, while other coded arrhythmias (n=2298) averaged 0.6/patient. AAD use post-index ablation was common (46.9% overall), ranging from 62.8 to 92.3% among patients with ≥1 reablation. Reablation was associated with AF phenotype (longstanding persistent vs. paroxysmal; IRR: 2.57 [95% CI: 1.45-4.18]); AAD use (vs. no use; 1.44 [1.31-1.58]); obstructive sleep apnea (vs. no obstructive sleep apnea; 1.34 [1.27-1.41]); valvular heart disease (vs. no valvular heart disease; 1.17 [1.11-1.23]); coronary artery disease (vs. no coronary artery disease; 1.15 [1.09-1.21]); and body mass index 30-35 kg/m2 (vs. <30 kg/m2; 1.09 [1.03-1.15]).
Conclusions: In this study, additional rhythm-control strategies were frequently continued after index ablation. One in 6 patients underwent repeat ablation, with the majority receiving concomitant AAD therapy. These data indicate that a combined strategy of catheter ablation and AADs is currently used in practice for rhythm control.
Editor-in-Chief
Kalyanam Shivkumar, MD, PhD, FACC
CME Editor
Kenneth A. Ellenbogen, MD, FACC
Author
Mahmoud Houmsse, MD, FACC
Important Dates
Date of Release: April 28, 2025
Term of Approval/Date of CME/MOC Expiration: April 27, 2026