Additional rhythm-control strategies are frequently continued after index ablation for atrial fibrillation (AFib), according to a study published Feb. 12 in JACC: Clinical Electrophysiology. One in six patients underwent repeat ablation, and the majority received concomitant antiarrhythmic drugs (AAD).

In the study, Sanjeev Saksena, MD, MBBS, FACC, et al., used Optum's deidentified Market Clarity Data to follow 23,323 patients after index ablation (mean age 63 years; 67.2% men). Most patients had one or more comorbidity, including hypertension, coronary artery disease (CAD), obstructive sleep apnea (OSA), diabetes or heart failure for newly diagnosed AFib until disenrollment, death or study end.

Results showed that after index ablation, a further 4,506 repeat ablations were carried out in 3,862 patients (16.6%), with either two ablations (14.2%), three (2.0%) or four or more (0.4%). Repeat ablation was associated with AFib phenotype, AAD use, OSA, valvular heart disease, CAD and a body mass index of 30-35 kg/m².

In the cohort with repeat ablations, incident individual AFib or atrial flutter events (7,907 total) averaged 2.0 per patient. Other coded arrhythmias (2,298) averaged 0.6 per patient; 503 patients had one or more ectopic supraventricular arrhythmia coded, and 502 had sick sinus syndrome coded following index ablation.

AAD use after initial ablation was common (46.9% overall). Among those patients who were AAD-naïve at index, 27.6% were prescribed AADs during follow-up. AAD use was generally higher as patients underwent two, three, or four or more ablations (62.8%, 69.9% and 68.6% respectively), with amiodarone being the most common in all cohorts.

The rate of all-cause mortality was 17.7 per 100 person-years for patients undergoing one or more ablation(s), with a mean age at death of 68.4 years. Among those who underwent repeat ablations, rates of comorbidities during follow-up were highest for OSA, depression, hypertension and valvular heart disease, and event rates of comorbidities were highest for chronic kidney disease, OSA, hypertension and diabetes.

"With increasing use of ablation for [AFib] management across age groups, often as first-line therapy, the management of recurrent [atrial tachyarrhythmia] and [AFib] has assumed greater importance," write the authors. "Although it has been suggested that repeat ablation might be superior to AAD use after ablation, real-world evidence across a broad demographic spectrum of patients with [AFib] with long-term follow-up is not readily available. Our study addresses this knowledge gap and defines the long-term incidence of repeat ablation and AAD use in current clinical practice across the [AFib] demographic spectrum spanning more than a decade."