Progression of atrial fibrillation after a failed initial ablation procedure in patients with paroxysmal atrial fibrillation: a randomized comparison of drug therapy versus reablation.

Background —The aim of this prospective randomized study was to assess if an early re-ablation was superior to AAD therapy in patients with previous failed PVI. Methods and Results —Patients with paroxysmal AF eligible for AAD therapy or re-ablation after a previous failed initial PVI procedure were eligible for this study and were followed for 3 years to assess rhythm by means of an implanted cardiac monitor. After the blanking period post-ablation, 154 patients had symptomatic AF recurrences and were randomized to AAD (N = 77) or to re-PVI (N = 77). At the end follow-up, 61 (79%) patients in AAD group and 19 (25%) patients in re-ablation group demonstrated AF% progression (p<0.01). The AF% at 36 months was significantly greater in the AAD group compared with patients in the re-ablation group, 18.8 ± 11.4% vs 5.6 ± 9.5%, respectively (p<0.01). In addition, 18 (23%) patients in AAD group and 3 (4%) patients in re-ablation group progressed to persistent AF (p<0.01). Moreover, 45 (58%) of the 77 re-ablation group patients became AF/AT-free on no antiarrhythmic drugs; in contrast, in the AAD group, only 9 (12%) of the 77 patients were AF/AT-free (p<0.01) throughout follow-up. Conclusions —Redo AF ablation was substantially more effective than AAD in reducing the progression and prevalence of AF after the failure of an initial ablation. Clinical Trial Registration Information —www.clinicaltrials.gov; Unique Identifier: [NCT01709682][1]. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01709682&atom=%2Fcircae%2Fearly%2F2013%2F06%2F07%2FCIRCEP.113.000495.atom