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CPP : Cardiovascular Prevention and Pharmacotherapy

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Review Article
Decision-making for recurrent atrial fibrillation after catheter ablation
Jum Suk Ko, Sung Soo Kim, Hyung Ki Jeong, Nam Ho Kim
Cardiovasc Prev Pharmacother. 2023;5(4):102-112.   Published online October 27, 2023
DOI: https://doi.org/10.36011/cpp.2023.5.e15
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Abstract PDF
Catheter ablation for atrial fibrillation (AF), especially pulmonary vein (PV) isolation, is widely used for rhythm control. However, AF recurrence remains a challenge, affecting 20% to 50% of cases. This review focuses on AF recurrence after catheter ablation. AF recurrence can be categorized into early recurrence (ER) within 3 months after index procedure, late recurrence (LR) within 1 year, and very LR (VLR) occurring beyond 1 year. ER has emerged as a significant predictor of LR, contrary to the traditional understanding. LR is primarily caused by PV reconnection, while VLR more involves non-PV triggers or substrates. Managing AF recurrence includes antiarrhythmic drugs, steroids, colchicine, and repeat ablation. Antiarrhythmic drugs reduce ER but have a limited impact on LR. Steroids have been shown to reduce ER, but not long-term recurrence. Colchicine, an anti-inflammatory agent, shows promise in reducing both ER and LR, although further research is necessary. Whether to perform early repeat ablation after ER remains uncertain, as not all patients require immediate intervention. In conclusion, AF recurrence after ablation remains a complex issue. Understanding the underlying mechanisms is essential for personalized management. Tailored approaches, considering individual characteristics, are crucial for long-term success. Future research should focus on improving therapeutic strategies for AF recurrence.

Citations

Citations to this article as recorded by  
  • Meta-analysis of Pulsed Field Ablation Versus Thermal Ablation for Pulmonary Vein Isolation in AF: A Broad Overview Focusing on Efficacy, Safety and Outcomes
    Mohammad Iqbal, William Kamarullah, Raymond Pranata, Iwan Cahyo Santosa Putra, Giky Karwiky, Chaerul Achmad, Young Hoon Kim
    Arrhythmia & Electrophysiology Review.2024;[Epub]     CrossRef
  • Beyond Clinical Factors: Harnessing Artificial Intelligence and Multimodal Cardiac Imaging to Predict Atrial Fibrillation Recurrence Post-Catheter Ablation
    Edward T. Truong, Yiheng Lyu, Abdul Rahman Ihdayhid, Nick S. R. Lan, Girish Dwivedi
    Journal of Cardiovascular Development and Disease.2024; 11(9): 291.     CrossRef

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