Cardiovasc Prev Pharmacother.  2023 Oct;5(4):102-112. 10.36011/cpp.2023.5.e15.

Decision-making for recurrent atrial fibrillation after catheter ablation

• Ko JS
• Kim SS
• Jeong HK
• Kim NH

• KMID: 2547301
• DOI: http://doi.org/10.36011/cpp.2023.5.e15

Abstract

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.

Keyword

Atrial fibrillation; Catheter ablation; Recurrence

Figure

• 

  Fig. 1. Mechanism of recurrence of atrial tachyarrhythmias according to the recurrence period. PV, pulmonary vein; SVC, superior vena cava; RA, right atrium; MA, mitral annulus; CT, crista terminalis; LA, left atrium; PW, posterior wall; AW, anterior wall; LAA, left atrium appendage; CS, coronary sinus; VOM, vein of Marshal.

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