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