Arrhythmia Recurrence and Rhythm Control Strategies After Catheter Ablation of Newly Diagnosed Atrial Fibrillation (ARRC-AF Study)
- PMID: 39945711
- DOI: 10.1016/j.jacep.2024.11.020
Arrhythmia Recurrence and Rhythm Control Strategies After Catheter Ablation of Newly Diagnosed Atrial Fibrillation (ARRC-AF Study)
Abstract
Background: Rhythm control in atrial fibrillation (AF) can be achieved with catheter ablation, but arrhythmia recurrences can require further interventions.
Objectives: The aim of this study was to characterize rhythm-control strategies after index ablation.
Methods: 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.
Results: 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/m2 (vs <30 kg/m2; IRR: 1.10; 95% CI: 1.02-1.20).
Conclusions: 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.
Keywords: antiarrhythmic drug therapy; atrial fibrillation; atrial tachyarrhythmias; catheter ablation; real-world evidence; repeat ablation.
Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Funding Support and Author Disclosures This study was funded by Sanofi. Dr Saksena is an advisory board member and research panel member for Sanofi; and has received a research grant from and is an investigator for Abbott. Dr Ken-Opurum and Mr Sistla are employees of Axtria, which received funding for this analysis from Sanofi. Drs McKindley and Preblick are employees of Sanofi and may hold shares and/or stock options in the company. Dr Rashkin was an employee of Sanofi at the time of the study and may hold shares and/or stock options in the company. Dr Hsu has received honoraria from Medtronic, Abbott, Boston Scientific, Biotronik, Pfizer, Sanofi, Janssen Pharmaceuticals, Bristol Myers Squibb, AltaThera Pharmaceuticals, Zoll Medical, Acutus Medical, Viz.ai, and Biosense Webster; has equity interest in Vektor Medical; and has received research grants from Biotronik and Biosense Webster. Dr Aldaas has reported that he has no relationships relevant to the contents of this paper to disclose.
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