Early recurrences after atrial fibrillation ablation: prognostic value and effect of early reablation

Introduction: Early arrhythmia recurrences are common within the first month after atrial fibrillation (AF) ablation. The long-term consequences of these early recurrences (ER) are controversial. We investigated whether ER were predictive of late recurrences and the impact of early reablation on clinical outcome.
Methods: Three hundred two consecutive patients with paroxysmal or persistent AF were studied. Arrhythmia recurrence was defined as documented episode of AF or atrial tachycardia. Of 151 patients with ER, a subset of 61 patients had reablation within the first month following the index ablation (early reablation). In the remaining 90 patients, a repeat procedure was only performed for later arrhythmia recurrences occurring beyond 1 month. Patients were followed with clinical interview and ambulatory 24 hours monitoring.
Results: Patients with and without early reablation had similar baseline characteristics including echocardiographic parameters and type of AF. During a mean follow-up of 11 ± 11 months, 82 patients (91%) without early reablation experienced late clinical recurrences. In contrast, patients with early reablation had lower rate of clinical recurrences (51% vs 91%, P < 0.0001) and fewer additional procedures (36% vs 91%, P < 0.0001). However, the total number of procedures over the entire follow-up was greater in those patients with early reablation (2.5 ± 0.7 vs 2.2 ± 0.6, P = 0.02).
Conclusion: An overwhelming majority of patients with recurrences within the first month after ablation have late recurrences. An early reablation reduces the incidence of further recurrences. However, the overall number of procedures is higher in the medium-term follow-up. The optimal timing for the second procedure remains to be defined.