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

Published July 17, 2015

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

Pokushalov, E. et al. Progression of atrial fibrillation after a failed initial ablation procedure in patients with paroxysmal atrial fibrillation: a randomized comparison of drug therapy versus reablation. Circ Arrhythm Electrophysiol. 2013 Aug;6(4):754-60. http://www.ncbi.nlm.nih.gov/pubmed/23748210. doi: 10.1161/CIRCEP.113.000495