Real‐World Outcomes of Repeat Ablation Strategies for Atrial Fibrillation: Insights From the Japanese Catheter Ablation Registry

Background Repeat ablation is often required in patients with atrial fibrillation (AF) due to recurrent arrhythmias. Although pulmonary vein isolation (PVI) is the only recommended ablation technique for repeat ablation, various additional strategies are commonly used in clinical practice. The purpose of this study was to evaluate the implementation, efficacy, and safety of repeat ablation strategies in Japan. Methods This study was conducted by using the Japanese Catheter Ablation Registry (J‐AB registry). A total of 26 684 patients who underwent a second ablation procedure for AF between August 2017 and December 2020 were included and analyzed for patient characteristics, procedural characteristics, and complications. Additionally, the AF recurrence rate over a 12‐month follow‐up period was also investigated in 1508 s ablation procedures. Results In the second ablation procedure, repeat‐pulmonary vein isolation (re‐PVI) was performed for 20 938 (78%) patients and 14 552 (55%) patients underwent left atrial additional ablation. Both of re‐PVI and left atrial additional ablation were performed for 10 086 (38%) patients. As the number of left atrial additional ablations in the second ablation procedure increased, the overall complication rate also significantly increased (paroxysmal AF, p < 0.001; persistent AF, p < 0.001). The rate of freedom from AF recurrence during the follow‐up period was 87.6% for paroxysmal AF and 80.6% for persistent AF. Conclusions In the second ablation procedure performed in Japan, re‐PVI was required in 78% of patients, and both of re‐PVI and left atrial additional ablation were performed for 38% of patients. As the number of left atrial additional ablations increased, the overall complication rate also increased. Trial Registration The J‐AB registry is registered in the UMIN Clinical Trial Registry (UMIN 000028288) and ClinicalTrials.gov (NCT03729232)