Impact of Recurrence-to-Repeat Ablation Time on Long-Term Efficacy and Safety of Patients With Paroxysmal Atrial Fibrillation: Time Matters.

Background: Rhythm control with catheter ablation has been established in the management of atrial fibrillation (AF), but the recurrence of AF remains significant. Several studies have demonstrated the benefits of repeat catheter ablation in patients with recurrent AF. However, the optimal timing for repeat ablation to minimize adverse atrial remodeling following recurrence has not been adequately investigated. In this study, we aimed to determine if an optimal timing for repeat catheter ablation existed in patients with recurrent AF.

Methods: We retrospectively screened 1131 patients receiving AF ablation at Taipei Veterans General Hospital and enrolled patients with paroxysmal AF undergoing repeat ablation procedures. Finally, 65 patients were enrolled for further analysis and patients are separated into two groups according to analysis of receiver operating characteristic (ROC) curve of recurrence to repeat ablation time (RAT).

Results: After analysis, the optimal RAT was 222 days, around 7.5 months, with a sensitivity of 56% and a specificity of 78% for 2nd recurrence. KM survival curve also demonstrated Group 2 (RAT ≥ 222) had higher recurrence of atrial arrhythmias after 2nd ablation (p = 0.01). In multivariable analysis, RAT was shown to be an independent predictor of long-term outcome in patient with AF.

Conclusions: Our study suggests that early repeat ablation might be advantageous in managing AF, extending arrhythmia-free intervals, and potentially preventing progression to more persistent arrhythmic forms. Given AF's progressive nature, these results advocate for early intervention strategies aimed at minimizing adverse atrial remodeling and enhancing quality of life for patients.