Outcomes after redo ablation for the recurrence of atrial fibrillation: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to summarize current practices, procedural findings during redo ablations and subsequent recurrence rates.

Catheter ablation is a cornerstone therapy for managing atrial fibrillation (AF). Despite its success in achieving rhythm control, many patients experience arrhythmia recurrence necessitating repeat ablation.

A systematic search of PubMed/MEDLINE, Web of Science, and Scopus was conducted through December 2023 to identify studies on first redo ablations for AF recurrence. The primary outcome was pooled prevalence estimates of AF recurrence after redo procedures.

Fifty-seven studies including 8,243 patients (median age 61.1 years) were analyzed. The mean duration between initial and redo procedures was 5.6 months. Pulmonary vein (PV) reconnection was observed in 81.9% of patients, with lower rates in those initially treated with cryoballoon ablation (CBA) (72.3%) compared to radiofrequency ablation (RFA) (85.9%). Most redo procedures were performed using RFA (95.4%), often with additional linear ablations such as cavotricuspid isthmus ablation (26.0%), mitral isthmus lines (7.8%), rooflines (8.7%), and posterior wall lines (7.0%). At a median follow-up of 11.5 months, 32.0% of patients experienced AF recurrence. Recurrence rates were significantly lower when the interval between initial and redo ablations was ≤ 12 months (25.5% vs. 33.9%).

Given the high prevalence of PV reconnections in patients with AF recurrence, re-isolation of the PVs remains the primary approach at repeat ablations, while additional ablative strategies are employed less frequently than anticipated. A shorter interval between the initial and redo ablation procedures was associated with reduced subsequent recurrence rates.