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antiarrhythmic

A-Fib Recurrence Post Ablation: Should you Have a Second Ablation? or Anti-Arrhythmic Drug Therapy?

Evgeny Pokushalov, MD, PhD

E. Pokushalov, MD, PhD

It’s disappointing when your heart doesn’t return to normal sinus rhythm (NSR) after your catheter ablation. What’s your next step, your follow-up treatment?

In his study, researcher Evgeny Pokushalov asked several related questions:

“If A-Fib recurs after a patient’s initial catheter ablation procedure, which is the better follow-up treatment? A second catheter ablation or taking antiarrhythmic meds?”

The Three-Year Study

In this study, 154 paroxysmal A-Fib patients who had a failed ablation were divided into two randomized groups.

A catheter ablation can profoundly change one’s life. And, even if you need a second ablation one.

The first group had a second ablation, the other group was put on antiarrhythmic drug therapy (AADs). The two groups were monitored by an implantable loop recorder, followed for three years, then compared.

Study Results

After three years, researchers found A-Fib present in 5.6% of the re-ablation group. In the antiarrhythmic drug group, 18.8% had A-Fib.

A second significant finding was the rate of paroxysmal A-Fib progressing to ‘persistent A-Fib’.  The re-ablation group had a progression rate of 4%, while the progress to “permanent A-Fib’ was 23% in the drug therapy group.

Expected and Unexpected Findings

I had expected (and it was confirmed) that the group getting a second ablation would have better results than the group on antiarrhythmic drug (AAD) therapy.

…progress to permanent A-Fib was 23% in the drug therapy group.

Many studies have documented this when patients undergo their first ablations vs AAD therapy.

What I didn’t expect was the rate of progression to persistent A-Fib in the second group. Nearly one-fourth (23%) of patients taking antiarrhythmic drugs progressed to persistent A-Fib after a failed ablation!

The Message is Clear 

To reduce your risk of progressing to persistent A-Fib, if you have a failed ablation, you are best served getting a second ablation rather than relying on antiarrhythmic drugs.

Are there benefits from a catheter ablation even when the patient’s A-Fib has not been eliminated? Yes! To learn more, see: Are There Benefits from a Failed Ablation? Yes!

References for this article

Follow-up Treatment After Failed Ablation: Second Ablation or Antiarrhythmic Drugs?

Evgeny Pokushalov, MD, PhD

E. Pokushalov, MD, PhD

Researcher Evgeny Pokushalov asked:

If A-Fib recurs after a patient’s initial catheter ablation procedure, which is the better follow-up treatment? A second catheter ablation or taking antiarrhythmic meds?

In this study, 154 paroxysmal A-Fib patients who had a failed ablation were divided into two groups. The first group had a second ablation. The second group was put on antiarrhythmic drug therapy. The two groups were followed for three years, then compared.

Three-Year Study Results

At the end of the follow-up period, 58% of patients who had a second ablation (group 1), were A-Fib free and without use of antiarrhythmic drugs (AADs); 4% of this group had progressed to persistent A-Fib.

Only 12% of those on antiarrhythmic drug therapy (group 2) were A-Fib free; 23% of this group had progressed to persistent A-Fib.

Editor’s Comments:
I had expected (and it was confirmed) that the group getting a second ablation would have better results than the group on antiarrhythmic drug (AAD) therapy. Many studies have documented this when patients undergo first ablations vs AAD therapy.
What I didn’t expect was the rate of progression to persistent A-Fib in the second group. Nearly one-fourth (23%) of patients taking antiarrhythmic drugs progressed to persistent A-Fib after a failed ablation!
The message is clear. To reduce your risk of progressing to persistent A-Fib, if you have a failed ablation, you are best served to get a second ablation rather than relying on antiarrhythmic drugs.
References for this article

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