Key result
Early cardioversion for post-ablation atrial tachyarrhythmias is linked to ~41% lower late recurrence risk.
Why the study?
Early recurrence of atrial tachyarrhythmias is common after pulmonary vein isolation for AF, and although electrical cardioversion is a treatment option, its optimal timing and association with late recurrence are unestablished.
Does electrical cardioversion during early recurrence of atrial tachyarrhythmias (days 1–30 vs days 31–90) reduce the risk of late recurrence of atrial tachyarrhythmias from day 91 to 365 in atrial fibrillation patients after pulmonary vein isolation?
Cohort (n=24,623)
Yes
Does electrical cardioversion during early recurrence of atrial tachyarrhythmias (days 1–30 vs days 31–90) reduce the risk of late recurrence of atrial tachyarrhythmias from day 91 to 365 in atrial fibrillation patients after pulmonary vein isolation?
Electrical cardioversion for early recurrent atrial tachyarrhythmia after pulmonary vein isolation is associated with a reduced risk of late arrhythmia recurrence up to one year, particularly when performed within the first 30 days.
ECV for ERAT after PVI was associated with lower LRAT risk, especially early; extends observational data but leaves open causal benefit in randomized trials.
Background Pulmonary vein isolation (PVI) is a well-established procedure for treating atrial fibrillation (AF); however, early recurrence of atrial tachyarrhythmias (ERAT) is common. Electrical cardioversion (ECV) is one treatment for ERAT, but optimal timing is unestablished. Purpose To evaluate the association between the timing of ECV for ERAT and the risk of late recurrence of atrial tachyarrhythmias (LRAT). Methods A retrospective cohort study using data from a global federated electronic health record network (TriNetX). We included AF patients undergoing PVI who developed ERAT within 90 days. Two ERAT periods were defined: early ERAT (days 1–30) and late ERAT (days 31–90). Within each stratum, patients were classified according to receipt of ECV versus no ECV and were 1:1 propensity score matched. The primary outcome was LRAT from day 91 to 365 post-ablation. Results A total of 24,623 patients with ERAT were included, of whom 1,506 underwent ECV (mean age 66.3 ± 9.5 years; 27.2% female) and 23,117 did not (mean age 64.4 ± 10.7 years; 33.1% female). After PSM, ECV was associated with statistically significant lower risk of LRAT in both early ERAT (HR 0.592; 95% CI 0.488–0.717) and late ERAT (HR 0.816; 95% CI 0.686–0.970) comparisons. After PSM, Patients who underwent ECV in early ERAT group compared to late ERAT group, had lower risk of LRAT (HR 0.80, 95% CI 0.67–0.94). Conclusions ECV during ERAT was associated with a lower risk of LRAT, with a stronger association in early vs late ERAT. Prospective studies should assess whether earlier ECV during the blanking period improves long-term rhythm outcomes.
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Serio et al. (2026) conducted a cohort in Early recurrent atrial tachyarrhythmia after pulmonary vein isolation for atrial fibrillation (n=24,623). Electrical cardioversion (ECV) for ERAT (early days 1-30 vs late days 31-90) vs. No electrical cardioversion (and late ECV days 31-90) was evaluated on Late recurrence of atrial tachyarrhythmias (LRAT) from day 91 to 365 post-ablation (HR 0.592, 95% CI 0.488-0.717). Electrical cardioversion for early recurrent atrial tachyarrhythmia lowered late recurrence risk in days 1-30 (HR 0.592; 95% CI 0.488-0.717) and days 31-90 (HR 0.816; 95% CI 0.686-0.970).
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