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 whether an early reablation was superior to antiarrhythmic drug (AAD) therapy in patients with previous failed pulmonary vein isolation.

METHODS AND RESULTS: Patients with paroxysmal atrial fibrillation (AF) eligible for AAD therapy or reablation after a previously failed initial pulmonary vein isolation procedure were eligible for this study and were followed up for 3 years to assess rhythm by means of an implanted cardiac monitor. After the blanking period postablation, 154 patients had symptomatic AF recurrences and were randomized to AAD (n=77) or repulmonary vein isolation (n=77). At the end of follow-up, 61 (79%) patients in the AAD group and 19 (25%) patients in the reablation group demonstrated AF% progression (P<0.01). The AF% at 36 months was significantly greater in the AAD group compared with patients in the reablation group (18.8±11.4% versus 5.6±9.5%, respectively; P<0.01). In addition, 18 (23%) patients in the AAD group and 3 (4%) patients in the reablation group progressed to persistent AF (P<0.01). Furthermore, 45 (58%) of the 77 reablation group patients were free of AF/atrial tachycardia on no AADs; in contrast, in the AAD group, only 9 (12%) of the 77 patients were free of AF/atrial tachycardia (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: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01709682.