{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T18:15:12Z","timestamp":1788459312950,"version":"build-2803163510"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Recurrence of symptomatic atrial fibrillation (AF) after catheter ablation (CA) is not uncommon. However, real-world long-term data on clinical outcomes of rhythm control strategies in patients with recurrent AF after CA remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Using the TriNetX database, we identified adult patients (\u226518 years) with recurrent AF after index CA. A 3-month blanking period was applied, during which no rhythm-control therapy was received. Patients were classified into two groups: repeat CA or initiation of antiarrhythmic drug (AAD) therapy. Propensity score matching (PSM) was performed to balance baseline characteristics. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated. Outcomes included all-cause mortality, all-cause hospitalization, heart failure (HF) exacerbation, ischaemic stroke, and major bleeding over 5 years. Among 4056 patients with recurrent AF post-CA, 17.2% underwent repeat CA. After PSM, 697 patients in the repeat CA group (mean age 68.9 \u00b1 9.6 years; 35.7% female) and 697 in the AAD group (mean age 68.4 \u00b1 10.0 years; 37.6% female) were analysed. Repeat CA was associated with lower all-cause mortality (3.3% vs 8.2%; HR 0.44; 95% CI, 0.27\u20130.72; P &amp;lt; 0.01), all-cause hospitalization (42.8% vs 56.4%; HR 0.71; 95% CI, 0.61\u20130.82; P &amp;lt; 0.01) and HF exacerbation (12.5% vs 24.8%; HR 0.50; 95% CI, 0.39\u20130.64; P &amp;lt; 0.01). No differences were observed in ischaemic stroke (5.3% vs 4.7%; HR 1.22; 95% CI, 0.77\u20131.96; P = 0.40) or major bleeding (4.6% vs 6.2%; HR 0.82; 95% CI, 0.52\u20131.29; P = 0.39).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Repeat CA was associated with lower mortality, hospitalization, and HF exacerbation over 5 years.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euag215","type":"journal-article","created":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T12:48:22Z","timestamp":1786798102000},"source":"Crossref","is-referenced-by-count":0,"title":["Management of recurrent atrial fibrillation after catheter ablation: 5-year outcomes of repeat catheter ablation vs. antiarrhythmic therapy"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5559-7236","authenticated-orcid":false,"given":"Yong Hao","family":"Yeo","sequence":"first","affiliation":[{"name":"Department of Internal Medicine\/Pediatrics, Corewell Health William Beaumont University Hospital , Royal Oak, MI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3387-2315","authenticated-orcid":false,"given":"Hermon Kha Kin","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Insight Hospital and Medical Center , Chicago, IL ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3758-0024","authenticated-orcid":false,"given":"Aravinthan","family":"Vignarajah","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cleveland Clinic Fairview Hospital , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7682-8934","authenticated-orcid":false,"given":"Min Choon","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Phoenix, AZ ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1619-2783","authenticated-orcid":false,"given":"Nishanthi","family":"Vigneswaramoorthy","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, SUNY Upstate Medical University , Syracuse, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2823-9243","authenticated-orcid":false,"given":"Justin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Cleveland Clinic Foundation , Cleveland, OH ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1010-1062","authenticated-orcid":false,"given":"Luis","family":"Scott","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Phoenix, AZ ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2808-3499","authenticated-orcid":false,"given":"Kamala P","family":"Tamirisa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, University of Texas Southwestern Medical Center , Dallas, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1976-6420","authenticated-orcid":false,"given":"Dan","family":"Sorajja","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Phoenix, AZ ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"DeSimone","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"2026090313320362800_euag215-B1","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1056\/NEJMoa1707855","article-title":"Catheter ablation for atrial fibrillation with heart failure","volume":"378","author":"Marrouche","year":"2018","journal-title":"N Engl J Med"},{"key":"2026090313320362800_euag215-B2","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1016\/j.jacc.2012.11.064","article-title":"Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal 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reablation","volume":"6","author":"Pokushalov","year":"2013","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2026090313320362800_euag215-B8","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1093\/eurheartj\/ehu017","article-title":"Optimal rhythm-control strategy for recurrent atrial tachycardia after catheter ablation of persistent atrial fibrillation: a randomized clinical trial","volume":"35","author":"Zhang","year":"2014","journal-title":"Eur Heart J"},{"key":"2026090313320362800_euag215-B9","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1093\/europace\/euac169","article-title":"Effect of repeat catheter ablation vs. Antiarrhythmic drug therapy among patients with recurrent atrial tachycardia\/atrial fibrillation after atrial fibrillation catheter ablation: data from CHINA-AF 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