{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T02:19:48Z","timestamp":1790734788618,"version":"4.1.0"},"reference-count":148,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T00:00:00Z","timestamp":1745366400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Atrial fibrillation (Afib) recurrence after catheter ablation (CA) remains a significant clinical challenge, driven by a complex and dynamic interplay of structural, electrical, and autonomic mechanisms. While pulmonary vein isolation (PVI) is the cornerstone of CA, recurrence rates remain substantial, highlighting the need to understand the evolving pathophysiology beyond PV reconnection. Post-ablation changes, including inflammation, edema, oxidative stress, and ischemia, create a transient proarrhythmic state that may contribute to early recurrence. Over time, atrial remodeling, fibrosis, and residual autonomic activity further sustain arrhythmogenicity. Additionally, epicardial adipose tissue promotes atrial myopathy, accelerating disease progression, particularly in patients with risk factors such as older age, female sex, obesity, hypertension, obstructive sleep apnea, and heart failure. The multifactorial nature of Afib recurrence underscores the limitations of a \u201cone-size-fits-all\u201d ablation strategy. Instead, a patient-specific approach integrating advanced mapping techniques, multimodal imaging, and computational modeling is essential. Artificial intelligence (AI) and digital twin models hold promise for predicting recurrence by simulating individualized disease progression and optimizing ablation strategies. However, challenges remain regarding the standardization and validation of these novel approaches. A deeper understanding of the dynamic interconnections between the mechanisms driving recurrence is crucial for improving long-term CA outcomes. This review explores the evolving nature of Afib recurrence, emphasizing the need for a precision medicine approach that accounts for the continuous interaction of pathophysiological processes in order to refine patient selection, ablation strategies, and post-procedural management.<\/jats:p>","DOI":"10.3390\/jcm14092919","type":"journal-article","created":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T10:40:48Z","timestamp":1745404848000},"page":"2919","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Beyond Pulmonary Vein Reconnection: Exploring the Dynamic Pathophysiology of Atrial Fibrillation Recurrence After Catheter Ablation"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0736-4942","authenticated-orcid":false,"given":"Panayotis K.","family":"Vlachakis","sequence":"first","affiliation":[{"name":"1st Department of Cardiology, \u201cHippokration\u201d General 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Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3561-5713","authenticated-orcid":false,"given":"Paschalis","family":"Karakasis","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Aristotle University of Thessaloniki, Hippokration General Hospital, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0995-7015","authenticated-orcid":false,"given":"Nikolaos","family":"Ktenopoulos","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, \u201cHippokration\u201d General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5008-114X","authenticated-orcid":false,"given":"Aristi","family":"Boulmpou","sequence":"additional","affiliation":[{"name":"Third Cardiology Department, Hippokration University Hospital of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Drakopoulou","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, \u201cHippokration\u201d General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6992-2906","authenticated-orcid":false,"given":"Ioannis","family":"Leontsinis","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, \u201cHippokration\u201d General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6203-6875","authenticated-orcid":false,"given":"Panagiotis","family":"Xydis","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, \u201cHippokration\u201d General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4093-4601","authenticated-orcid":false,"given":"Athanasios","family":"Kordalis","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, \u201cHippokration\u201d General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1610-0156","authenticated-orcid":false,"given":"Ioanna","family":"Koniari","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6628-0303","authenticated-orcid":false,"given":"Konstantinos A.","family":"Gatzoulis","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, 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