A 51-year-old man with a persistent left superior vena cava (PLSVC) underwent catheter ablation using the PulseSelect PFA Loop catheter (Medtronic). During the procedure, sustained atrial tachycardia (AT) was observed an...A 51-year-old man with a persistent left superior vena cava (PLSVC) underwent catheter ablation using the PulseSelect PFA Loop catheter (Medtronic). During the procedure, sustained atrial tachycardia (AT) was observed and identified as a macro-reentrant circuit involving the PLSVC. Pulsed field ablation (PFA) applied within the PLSVC successfully terminated the AT without complications. This is a case of macro-reentrant AT involving the PLSVC-left atrium epicardial connection, in which both intracardiac mapping and treatment were performed only using PFA, demonstrating its potential as a safe and effective therapeutic strategy in this challenging anatomical context.
Twiddler's syndrome is a known complication of CIED implantation. Most published cases of Twiddler's syndrome are described as being secondary to patient manipulation of the pulse generator leading to horizontal rotation...Twiddler's syndrome is a known complication of CIED implantation. Most published cases of Twiddler's syndrome are described as being secondary to patient manipulation of the pulse generator leading to horizontal rotation and "reeling" of the pacemaker leads around the generator. The authors of this paper present a case of an 81-year-old female who had her anchoring suture across the pulse generator break after implant. This led to rotation of the pulse generator in the vertical axis and subsequently led to RV lead rotation in the longitudinal axis. The patient developed rising thresholds and low impedance on the RV lead, with fluoroscopy confirming an insulation break and lead fracture. Due to the nature of the lead rotation, extraction was impossible, and the lead was capped and buried. The case report highlights a unique mechanism by which a lead can rotate along its longitudinal axis, and is a reminder to implanting physicians regarding the importance of proper anchoring techniques.
INTRODUCTION: Paroxysmal supraventricular tachycardia (PSVT) is a common cause of palpitations, with atrioventricular nodal re-entrant tachycardia (AVNRT) accounting for up to 60% of cases. In approximately 5% of patient...INTRODUCTION: Paroxysmal supraventricular tachycardia (PSVT) is a common cause of palpitations, with atrioventricular nodal re-entrant tachycardia (AVNRT) accounting for up to 60% of cases. In approximately 5% of patients, tachycardia is non-inducible during electrophysiology (EP) study, despite the presence of dual AV nodal physiology (DAVNP). The optimal management of patients with DAVNP and non-inducible tachycardia, whether to perform empiric ablation or not to ablate remains uncertain. OBJECTIVE: To compare recurrence rates, mechanism of recurrence and timing of recurrence between patients who underwent empiric slow pathway ablation versus those who did not. METHODS: We retrospectively reviewed EP studies from 2010 to 2024. Patients with documented adenosine responsive PSVT, DAVNP but non-inducible tachycardia were included; those with accessory pathways or structural heart disease were excluded. Among 1, 890 patients, 76 met inclusion criteria: Group I (n = 20) underwent empiric ablation, and Group II (n = 56) did not. RESULTS: The mean age was 50.2 ± 16 years, and 62% were female. During a mean follow-up of 3.8 years, recurrence rates were similar (15% vs. 26.7%, p = 0.28)., but no patients in empiric ablation group had AVNRT whereas 53% of non-ablation patients had AVNRT. All the early recurrences were due to AVNRT while the late recurrences were predominantly due to non AVNRT arrhythmias. Time to recurrence was longer in the ablation group (54 vs. 9.8 months). There were no AV blocks after empiric ablation CONCLUSION: In patients with DAVNP and non-inducible tachycardia, overall recurrence rates are similar regardless of empiric ablation, however it is efficacious is preventing early arrhythmia recurrence and true AVNRT recurrences.
Cristiano E, Celentano E, Ignatiuk B
… +5 more, Renda M, Bia E, Rainone R, Viganò J, De Groot NMS
Pacing Clin Electrophysiol
· 2026 Jul · PMID 41810724
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BACKGROUND: Very-high-power-short-duration (vHPSD) ablation is increasingly adopted for pulmonary vein isolation (PVI) in atrial fibrillation (AF). While inadequate catheter-tissue contact is known to impair lesion forma...BACKGROUND: Very-high-power-short-duration (vHPSD) ablation is increasingly adopted for pulmonary vein isolation (PVI) in atrial fibrillation (AF). While inadequate catheter-tissue contact is known to impair lesion formation under fixed 90 W/4-s setting, independent role of probe stability versus rapid oscillatory motion has not been quantitatively defined. OBJECTIVE: To evaluate the independent and interactive effects of contact force (CF), positional stability (PS/PSV), and oscillation (OS/OSV) on lesion biophysics during vHPSD ablation in vivo. METHODS: We retrospectively analyzed 80 consecutive AF patients undergoing PVI with a QDOT-MICRO catheter in vHPSD-mode (90 W/4-s, temperature-controlled). For each application (5198), CARTO3 trace data provided impedance, temperature, tip-to-tag distance, and CF (62.5Hz-sample). Stability parameters were defined as mean and variability of tip-to-tag distance (PS, PSV); oscillation parameters as mean and variability of tip velocity (OS, OSV). Primary endpoints were impedance drop (ID) and maximum temperature (Tmax). Mixed-effects regression models adjusted for baseline impedance, temperature, and CF; sensitivity analyses tested operator effect, and regional segments. RESULTS: Minimum CF (p < 0.001) and oscillation parameters (OS p < 0.001, OSV p = 0.004) were the strongest predictors of ID and Tmax, whereas stability parameters had attenuated effects after adjustment. Interactions showed that increasing PSV and OSV reduced ID and Tmax, especially under higher CF. Regional analysis confirmed modestly lower signals in posterior/inferior segments, but oscillation remained the main determinant. CONCLUSION: Oscillation, more than positional stability, is the primary motion determinant of lesion efficacy in vHPSD. Minimizing oscillation rather than increasing CF is key to optimizing energy delivery. Prospective studies should assess whether reducing oscillation improves long-term outcomes.
Sciacca V, Brandt NK, Fink T
… +12 more, Guckel D, Mörsdorf M, Bocchini Y, Braun M, Khalaph M, Harutyunyan K, Trajkovska N, Lucas P, Eitz T, Didenko M, Sommer P, Sohns C
Pacing Clin Electrophysiol
· 2026 Jun · PMID 41805092
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BACKGROUND: While interventional strategies have expanded the options for long term rhythm restoration, rate control continues to play a pivotal role in the treatment of atrial arrhythmias; however, pharmacologic strateg...BACKGROUND: While interventional strategies have expanded the options for long term rhythm restoration, rate control continues to play a pivotal role in the treatment of atrial arrhythmias; however, pharmacologic strategies alone often fail in achieving effective rate control. AIMS: To examine long-term outcomes in patients who have undergone atrioventricular node ablation (AVNA) for the management of symptomatic atrial arrhythmias. METHODS: This observational Study Assessed Patients Who Underwent AVNA For Rate Control of Atrial Fibrillation (AF) Or Atrial Tachycardia (AT) Between April 2014 and February 2022. Clinical data, along with follow-up information including cardiac device interrogation were analyzed. A composite safety endpoint, Encompassing Heart Failure (HF) Rehospitalization, lead revision, device infection, or upgrade for cardiac resynchronization therapy (CRT), was evaluated. Additionally, structured patient interviews were conducted to assess quality of life outcomes. RESULTS: 192 patients (76 females (39.6%), mean age 73.7 ± 10 years) were included into the study. Patients suffered from paroxysmal AF in 10 cases (5.2%), persistent AF in 138 cases (71.9%) and AT in 44 cases (22.9%). Acute AVNA was successful in all patients. Two pseudoaneurysms at the femoral puncture site occurred as the only periprocedural complications. Mean follow-up duration was 907.0 ± 609.7 days. Persistent complete AV block was present in 191 patients (99.5%) during follow-up. The composite safety endpoint occurred in 58 (30.2%) patients. Quality of life significantly improved in most patients with a relevant regression in EHRA and NYHA scores. CONCLUSION: AVNA is effective and safe in an all-comer patient population with high success rates in terms of rate control, QOL improvement and a favorable safety profile during long-term observation.
Specific tachycardia characteristics, such as the zones of initiation, transition, and termination, may yield important insights into the underlying mechanism of the tachycardia even before diagnostic maneuvers are perfo...Specific tachycardia characteristics, such as the zones of initiation, transition, and termination, may yield important insights into the underlying mechanism of the tachycardia even before diagnostic maneuvers are performed.
BACKGROUND: Pulse field ablation (PFA) is an emerging catheter ablation strategy for patients with atrial fibrillation (AF). Nonetheless, the safety and efficacy of PFA in elderly patients remains scarce. Hence, this stu...BACKGROUND: Pulse field ablation (PFA) is an emerging catheter ablation strategy for patients with atrial fibrillation (AF). Nonetheless, the safety and efficacy of PFA in elderly patients remains scarce. Hence, this study is to provide a comprehensive review of PFA utilization in the elderly. METHODS: A systematic search was conducted from the inception of PubMed to July 2025 comparing the safety and efficacy of PFA in elderly (≥75 years) and non-elderly patients. Safety outcomes were the rate of overall procedure-related complications, major complications (stroke/TIA, cardiac tamponade, phrenic nerve injury, valve damage, myocardial infarction), and minor complications. Efficacy outcomes include time to arrhythmia recurrence and rate of arrhythmia-free survival. RESULTS: Ten studies with a total of 5948 patients (900 elderly and 5048 non-elderly) were included in the analysis. In the elderly group, the rate of overall and major complications was 3% (95% CI 2%-6%, I = 0%) and 1% (95% CI 1%-2%, I= 0), respectively. However, elderly patients still had a higher risk of overall complications (OR 1.93, 95% CI 1.29-2.91, I = 0%, p = 0.020), major complications (OR 1.93, 95% CI 1.11-3.35, I = 0%, p = 0.033), and minor complications (OR 2.08, 95% CI 1.19-3.64, I = 0%, p = 0.030), compared to non-elderly patients. The rate of arrhythmia-free survival was similar in each group (OR 0.81, 95% CI 0.41-1.59, I = 0%, p = 0.315). No significant differences were observed in procedural time (MD -2.54 min, 95% CI -14.76 to 9.68, I = 88.6%, p = 0.595) and fluoroscopy time (MD -0.8 min, 95% CI -3.11 to 1.51, I = 80%, p = 0.392). CONCLUSION: Our study demonstrated that, in the elderly, there was a similar efficacy in PFA for AF, but with a higher tendency for complications, compared to non-elderly patients.
BACKGROUND: Rate-dependent left bundle branch block (rdLBBB) is a unique clinical entity diagnosed in 0.5%-1% of the patients undergoing exercise testing. OBJECTIVE: This study aimed to evaluate the electromechanical fea...BACKGROUND: Rate-dependent left bundle branch block (rdLBBB) is a unique clinical entity diagnosed in 0.5%-1% of the patients undergoing exercise testing. OBJECTIVE: This study aimed to evaluate the electromechanical features in this acute and transient onset of left bundle branch block (LBBB) during exercise testing, and to assess its natural history. METHODS: Fifty patients with rdLBBB were retrospectively analyzed. If a stress echocardiography was feasible, they were prospectively included for a supine bicycle echocardiography to evaluate electromechanical dyssynchrony. RESULTS: RdLBBB fulfills the criteria of LBBB in 95% of the patients. Sixty percent of the patients with rdLBBB progressed to a permanent LBBB within 3 years, with a lower heart rate at onset of rdLBBB and left ventricular ejection fraction (LVEF) as predictors. rdLBBB was characterized by acute mechanical dyssynchrony with septal flash (SF). Patients with lower baseline LVEF had more pronounced SF and a higher strain stage (p = 0.001). The electromechanical dyssynchrony was associated with more left ventricular dysfunction during exercise (p = 0.045). CONCLUSION: RdLBBB is a relative rare clinical entity, which is characterized by sudden onset and typical LBBB, fulfilling criteria of LBBB. The degree of dyssynchrony during rdLBBB seems to be determined by the baseline LVEF, with possible acute LV dysfunction during exercise.
BACKGROUND: Early complications after cardiac implantable electronic device (CIED) implantation remain clinically relevant and have been widely examined in large registry studies. Advanced age, comorbidities, device comp...BACKGROUND: Early complications after cardiac implantable electronic device (CIED) implantation remain clinically relevant and have been widely examined in large registry studies. Advanced age, comorbidities, device complexity, and antithrombotic therapy are recognized predictors of early complications. This study planned to examine the effect of sex on early (≤ 30 days) device-related complications and to determine independent predictors of early major adverse cardiac events (MACE). METHODS: This retrospective, single-center study enrolled 1807 sequential patients (729 women, 1078 men) undergoing pacemaker, implantable cardioverter-defibrillator, or cardiac resynchronization therapy implantation. Early MACE was described as consisting of pocket hematoma, pneumothorax, pericardial effusion/tamponade, and device-related infection within 30 days. Univariable and multivariable logistic regression analyses were conducted to determine autonomous prognostic factors. RESULTS: Early MACE occurred in 26 (3.6%) women and 41 (3.8%) men (p = 0.893). Device type distribution differed significantly by sex, with defibrillators more frequently implanted in men and pacemakers and resynchronization devices in women (all p < 0.001). Sex was not independently related to early MACE (OR 1.28, 95% CI 0.77-2.13; p = 0.337). Higher PORT scores (OR 1.06, p = 0.035), higher white blood cell counts (OR 1.09, p = 0.004), lower hemoglobin levels (OR 0.86, p = 0.024), and the presence of heart failure (OR 0.35, p = 0.002) remained independent predictors of early MACE. CONCLUSION: Early CIED-related complications were infrequent and occurred at similar rates in women and men. Sex was not an independent predictor of early MACE; instead, overall clinical risk burden and systemic factors were the primary determinants of early adverse outcomes.
BACKGROUND: Left bundle branch pacing (LBBP) is emerging as a physiological pacing strategy. However, data on its feasibility and safety in nonagenarians (≥90 years) with symptomatic bradycardia are limited. This study a...BACKGROUND: Left bundle branch pacing (LBBP) is emerging as a physiological pacing strategy. However, data on its feasibility and safety in nonagenarians (≥90 years) with symptomatic bradycardia are limited. This study aims to evaluate the outcomes of LBBP in this frail, high-risk population. METHODS: A retrospective analysis was conducted on 8 patients aged 90 and older who underwent LBBP between December 2023 and December 2024. Procedural outcomes, complications, and pacing parameters were assessed. RESULTS: LBBP was successfully performed in 8 patients (mean age 93 ± 2 years, mean Clinical Frailty Score 5). The pacing indications included atrioventricular block and sinus node dysfunction. The mean left ventricular activation time was 75 ± 8 ms. At a median follow-up of 6 weeks, pacing parameters remained stable with no evidence of lead displacement, haematoma, or infection. There were no immediate procedural complications. CONCLUSIONS: LBBP appears to be a feasible and safe physiological pacing strategy in nonagenarians with symptomatic bradycardia. Further studies are needed to confirm the long-term outcomes of LBBP in elderly patients.
BACKGROUND: Leadless pacemaker implantation traditionally relies on fluoroscopy and contrast-guided techniques. However, in patients with advanced chronic kidney disease, the use of contrast carries a risk of nephrotoxic...BACKGROUND: Leadless pacemaker implantation traditionally relies on fluoroscopy and contrast-guided techniques. However, in patients with advanced chronic kidney disease, the use of contrast carries a risk of nephrotoxicity, and fluoroscopy leads to additional ionizing radiation exposure. CASE SUMMARY: We report a case of a 69-year-old man with occasional sinus arrest and end-stage renal disease on hemodialysis who successfully underwent implantation of an Aveir VR leadless pacemaker (Abbott, USA) entirely under transthoracic echocardiographic (TTE) guidance, without fluoroscopy or contrast. Using a Philips EPIQ system with an X5-1 transducer, key procedural steps-including navigation, septal positioning, pacing threshold testing, and final deployment-were completed under real-time ultrasound visualization. Post-procedural pacing parameters were optimal, and no complications occurred. Chest radiography confirmed appropriate device position. CONCLUSION: This case demonstrates the potential feasibility and safety of an ultrasound-guided implantation technique for the Aveir VR leadless pacemaker. It may offer a promising alternative for patients with contraindications to radiation or contrast agents. Larger studies are needed to validate and standardize this approach.
BACKGROUND: Permanent pacemaker (PPM) implantation is recommended in patients with sinus node dysfunction (SND). In patients with coexisting heart failure with preserved ejection fraction (HFpEF), clinicians may be hesit...BACKGROUND: Permanent pacemaker (PPM) implantation is recommended in patients with sinus node dysfunction (SND). In patients with coexisting heart failure with preserved ejection fraction (HFpEF), clinicians may be hesitant to treat SND due to concerns about exacerbating heart failure. Little is known about real-world PPM utilization and disease burden in the HFpEF population that has been assumed to benefit from low heart rates. This study aims to characterize the disease burden and PPM utilization in patients with SND+HFpEF versus SND-only in a Medicare population. METHODS: Patients diagnosed with SND were identified in the Medicare administrative claims database and stratified by presence or abscence of prior evidence of HFpEF. Rates of the following clinical outcomes were compared between the cohorts during follow-up: PPM implant, HF hospitalization, atrial fibrillation (AF) hospitalization, second/third-degree AV block or HFrEF, myocardial infarction (MI), ischemic stroke, and all-cause mortality. RESULTS: SND+HFpEF (N = 26,986) patients were older (81.1 vs. 78.5, p < 0.0001) and more likely to be female (63.5% vs. 49.9%, p < 0.0001) than SND-only patients (N = 74,269). Median follow-up time was 884 days (IQR 476-1408). The PPM implant rate during follow-up was lower in the SND+HFpEF population (HR = 0.811, p < 0.0001). The SND+HFpEF population had higher HF and AF hospitalizations (HR = 2.229 and HR = 1.174, both p < 0.0001), and higher incidence of second/third-degree AV block and HFrEF (HR = 1.364 and HR = 1.640, both p < 0.0001) than the SND-only population. CONCLUSIONS: PPM implant rates were lower, and overall disease burden was greater in HFpEF+SND patients compared to SND-only patients. Future work should focus on optimizing treatment pathways for patients with HFpEF and SND.
Pacing Clin Electrophysiol
· 2026 Jul · PMID 41755352
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BACKGROUND: The increasing use of cardiac implantable electronic devices (CIED) is leading to a rise in procedure-related complications. OBJECTIVE: This trial aimed to assess the safety and feasibility of early mobilizat...BACKGROUND: The increasing use of cardiac implantable electronic devices (CIED) is leading to a rise in procedure-related complications. OBJECTIVE: This trial aimed to assess the safety and feasibility of early mobilization and the possibility of same-day discharge following permanent pacemaker implantation. METHODS: 200 patients were enrolled from 3/2019 to 12/2023 in this trial. Participants were randomly assigned to the Early Mobilization arm with 4 h of post-procedure bed rest or the Late Mobilization arm with 16-24 h of post-procedure bed rest. Primary endpoints include a composite of common complications: hematoma, major bleeding, wound infections, pneumothorax, and lead dislodgement. Secondary endpoints compared the incidence of individual complications from primary endpoints and changes in the technical parameters of the CIED between the two groups. Follow-ups were at 1 and 6 months. RESULTS: Two hundred patients were enrolled, 191 (95.5%) had the 6-month follow-up. About 150 patients received a dual lead device, and 50 received a single lead device. There were no significant differences in primary composite complications (EaM vs. LaM; four cases, 4% vs. seven cases, 7%; p = 0.548). There were no significant differences in secondary endpoints EaM vs. LaM; atrial lead dislodgement (2 vs. 2), ventricular lead dislodgement (0 vs. 0), and wound infection (1 vs. 0), respectively. Technical parameters remained stable in both arms without any significant differences, for example, a drop in sensing or an increase in the stimulation threshold. CONCLUSION: The early mobilization protocol is safe, and the incidence of complications is no higher than that of late mobilization.
Delayed lead perforation into the left ventricular (LV) cavity after left bundle branch area pacing (LBBAP) is less common than in the acute setting and could be associated with severe adverse events. We present the case...Delayed lead perforation into the left ventricular (LV) cavity after left bundle branch area pacing (LBBAP) is less common than in the acute setting and could be associated with severe adverse events. We present the case of a young patient with symptomatic second-degree atrioventricular block who developed partial protrusion of the LBBAP lead into the LV cavity after discharge. While adequate conduction system capture was still seen with bipolar pacing, this potentially serious complication was self-diagnosed by the patient due to the initial ventricular pacing programming in a unipolar setting, which revealed the complete loss of capture.
Hussain B, Duhan S, Akhtar KH
… +5 more, Seri AR, Akrawinthawong K, Gorthi J, Keisham B, Dasari T
Pacing Clin Electrophysiol
· 2026 Jul · PMID 41741887
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INTRODUCTION: Cardiac amyloidosis can cause congestive heart failure, arrhythmias, and heart blocks, which frequently require cardiac device implantation (CDI). However, the differences between light chain (AL) amyloidos...INTRODUCTION: Cardiac amyloidosis can cause congestive heart failure, arrhythmias, and heart blocks, which frequently require cardiac device implantation (CDI). However, the differences between light chain (AL) amyloidosis and transthyretin (ATTR) amyloidosis CDI requirements are unknown. METHODS: A retrospective analysis was conducted using the National Inpatient Sample 2017-2020 with respective ICD-10 codes. Weighted multivariate regression was used to analyze in-hospital mortality by adjusting for confounders. RESULTS: Among 1,008,010 patients hospitalized for CDI, 160 patients had underlying AL-AMD, while 200 patients had underlying ATTR-AMD. Patients undergoing CDI with underlying ATTR-AMD had a higher mean age (76.7 vs. 68.4 years, p = 0.001), and a higher male proportion (80% vs. 46.8%, p = 0.005) as compared to those with AL-AMD. ATTR-AMD had a higher CDI rate than AL-AMD (1.4% vs. 8.3%). The predominant device implanted in both AL-AMD and ATTR-AMD was a permanent pacemaker (PPM) (0.8% vs. 5.7%). Underlying AL-AMD was associated with higher in-hospital mortality in patients undergoing PPM (OR 5.1, CI 1.3-19, p = 0.01), and implantable-cardioverter defibrillator (ICD) implantation (OR 21.5, CI 4.6-99, p < 0.001). Patients undergoing CDI with underlying AL-AMD had a higher mean length of stay. CONCLUSION: ATTR-AMD has a higher CDI rate as compared to AL-AMD. Underlying AL-AMD is associated with higher in-hospital mortality in patients undergoing PP and ICD implantation.
BACKGROUND: Early recurrence of atrial tachyarrhythmia (ERAT) during the 90-day blanking period after pulmonary vein isolation (PVI) remains a challenge and has been associated with increased healthcare utilization and p...BACKGROUND: Early recurrence of atrial tachyarrhythmia (ERAT) during the 90-day blanking period after pulmonary vein isolation (PVI) remains a challenge and has been associated with increased healthcare utilization and patient anxiety. Comparative data on ERAT incidence across energy modalities, including pulsed field ablation (PFA), high-power short-duration (HPSD), very high-power short-duration (vHPSD), and cryoballoon ablation, are limited. OBJECTIVES: To assess and compare the incidence and timing of ERAT following PVI using four ablation technologies. METHODS: In this single-center observational cohort study, 671 consecutive patients undergoing first-time PVI were screened. One hundred consecutive patients undergoing cryoballoon ablation were included as reference group, and three additional groups (HPSD, vHPSD, PFA; each n = 100) were propensity score-matched based on age, sex, BMI, and AF type. ERAT was defined as a clinically detected episode of atrial fibrillation or atrial tachycardia lasting >30 s within 90 days after PVI, documented by 12-lead ECG or Holter monitoring during scheduled or clinically indicated rhythm surveillance. Procedural characteristics, procedural success, and safety were evaluated. RESULTS: Among 400 matched patients, PFA was associated with a significantly lower ERAT incidence compared to thermal ablation (3% vs. 15%-19%, p < 0.01). In PFA patients, ERAT occurred exclusively between Days 31 and 90. Thermal energy groups showed higher rates of early recurrences, often requiring clinical interventions, including hospitalizations and cardioversions. Multivariate analysis did not identify any additional clinical predictors of ERAT. CONCLUSIONS: PFA was associated with a significantly lower rate of early arrhythmias, which may be related to differences in tissue injury mechanisms. These findings suggest PFA may offer a clinical advantage in reducing clinically relevant ERAT and the associated healthcare burden after PVI.
BACKGROUND: Suppressing atrial remodeling by reducing atrial fibrillation (AF) burden during the blanking period (BP) after AF ablation may lead to subsequent suppression of AF recurrence. However, the management of earl...BACKGROUND: Suppressing atrial remodeling by reducing atrial fibrillation (AF) burden during the blanking period (BP) after AF ablation may lead to subsequent suppression of AF recurrence. However, the management of early recurrences (ERs) remains controversial. Herein, we examined the impact of aggressive strategies to restore and maintain sinus rhythm following AF ablation recurrence. METHODS: This retrospective cohort study initially included 681 consecutive patients who underwent an initial radiofrequency catheter ablation (RFCA) for AF at two centers; 151 patients with ERs of atrial tachyarrhythmias within 3 months post-RFCA were included in the final analysis. Participants were divided into two groups based on the treatment received: Group A, aggressive strategy (n = 112, paroxysmal: 49) and Group B, conservative strategy (n = 39, paroxysmal: 14). Baseline characteristics, clinical parameters, and recurrence rates 12 months after ablation (12m) were compared between groups. Both groups were stratified by AF type and similarly assessed. RESULTS: A significant difference was observed in the 12m recurrence-free rate between the groups (Group A: 82/112 [73.2%] vs. Group B: 21/39 [53.9%]; p = 0.016). The aggressive strategy was associated with a lower risk of 12m recurrence (adjusted hazard ratio, 0.24; 95% confidence interval, 0.08-0.74; p = 0.013). Among patients with paroxysmal AF (PAF), no difference was observed (Group A: 35/49 [71.4%] vs. Group B: 9/13 [69.2%]; p = 0.887); however, in those with non-PAF, the 12m recurrence-free rate was higher in Group A than in Group B (47/63 [74.6%] vs. 12/26 [46.2%]; p = 0.004). CONCLUSIONS: Aggressive strategies for ERs can reduce subsequent recurrences following AF ablation, especially in patients with non-PAF.