Management of Recurrent Atrial Fibrillation After Catheter Ablation: Five-Year Outcomes of Repeat Catheter Ablation Versus Antiarrhythmic Therapy.

BACKGROUND: Recurrence of symptomatic atrial fibrillation (AF) after catheter ablation (CA) is not uncommon. However, real-world long-term data on clinical outcomes of rhythm control strategies in patients with recurrent AF after CA remain limited. METHODS: Using the TriNetX database, we identified adult patients (≥18 years) with recurrent AF after index CA. A 3-month blanking period was applied, during which no rhythm-control therapy was received. Patients were classified into two groups: repeat CA or initiation of antiarrhythmic drug (AAD) therapy. Propensity score matching (PSM) was performed to balance baseline characteristics. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated. Outcomes included all-cause mortality, all-cause hospitalization, heart failure (HF) exacerbation, ischemic stroke, and major bleeding over 5 years. RESULTS: Among 4,056 patients with recurrent AF post-CA, 17.2% underwent repeat CA. After PSM, 697 patients in the repeat CA group (mean age 68.9 ± 9.6 years; 35.7% female) and 697 in the AAD group (mean age 68.4 ± 10.0 years; 37.6% female) were analyzed. Repeat CA was associated with lower all-cause mortality (3.3% vs 8.2%; HR 0.44; 95% CI, 0.27-0.72; P < 0.01), all-cause hospitalization (42.8% vs 56.4%; HR 0.71; 95% CI, 0.61-0.82; P < 0.01) and HF exacerbation (12.5% vs 24.8%; HR 0.50; 95% CI, 0.39-0.64; P < 0.01). No differences were observed in ischemic stroke (5.3% vs 4.7%; HR 1.22; 95% CI, 0.77-1.96; P = 0.40) or major bleeding (4.6% vs 6.2%; HR 0.82; 95% CI, 0.52-1.29; P = 0.39). CONCLUSIONS: Repeat CA was associated with lower mortality, hospitalization, and HF exacerbation over 5 years.