Following index catheter ablation for newly diagnosed atrial fibrillation, 16.6% of patients required repeat ablation and 46.9% utilized antiarrhythmic drugs.
Cohort (n=23,323)
A combined strategy of catheter ablation and antiarrhythmic drugs is frequently required and utilized in real-world practice for rhythm control following index ablation for newly diagnosed atrial fibrillation.
Rhythm control in atrial fibrillation (AF) can be achieved with catheter ablation, but arrhythmia recurrences can require further interventions. The aim of this study was to characterize rhythm-control strategies after index ablation. A total of 2,429,863 patients in Optum’s deidentified Market Clarity Data who underwent index ablation for newly diagnosed AF (2007-2021) were followed until disenrollment, death, or study end. Repeat ablations; AF, atrial flutter, or other tachycardias following index ablation; and antiarrhythmic drug (AAD) practices after ablation were examined. In total, 23,323 patients underwent index ablation (median follow-up duration 1,165 days); 3,862 (16.6%) underwent ≥2 ablations (2 ablations, 14.2%; 3 ablations, 2.0%; ≥4 ablations, 0.4%). In patients with repeat ablations, incident individual AF or atrial flutter patient events (n = 7,907) averaged 2.0 per patient, while other coded arrhythmias (n = 2,298) averaged 0.6 per patient. AAD use after index ablation was common (46.9% overall), ranging from 62.8% to 92.3% among patients with ≥1 repeat ablation. Repeat ablation was associated with AF phenotype (long-standing persistent vs paroxysmal; incidence rate ratio IRR: 2.26; 95% CI: 1.27-3.68), AAD use (vs no use; IRR: 1.42; 95% CI: 1.30-1.56), obstructive sleep apnea (vs no obstructive sleep apnea; IRR: 1.26; 95% CI: 1.20-1.33), valvular heart disease (vs no valvular heart disease; IRR: 1.12; 95% CI: 1.07-1.18), coronary artery disease (vs no coronary artery disease; IRR: 1.13; 95% CI: 1.07-1.19), and body mass index 30 to 35 kg/m 2 (vs <30 kg/m 2 ; IRR: 1.10; 95% CI: 1.02-1.20). In this study, additional rhythm-control strategies were frequently continued after index ablation. One in 6 patients underwent repeat ablation, with the majority receiving concomitant AAD therapy. These data indicate that a combined strategy of catheter ablation and AADs is currently used in practice for rhythm control.
Saksena et al. (Wed,) conducted a cohort in Newly diagnosed atrial fibrillation (n=23,323). Index catheter ablation was evaluated on Repeat ablation. Following index catheter ablation for newly diagnosed atrial fibrillation, 16.6% of patients required repeat ablation and 46.9% utilized antiarrhythmic drugs.