Early recurrence of atrial tachyarrhythmia (ERAT) is common after pulmonary vein isolation (PVI) and has been associated with an increased risk of late AF recurrence.

We sought to determine the incidence and outcomes of patients experiencing ERAT after PVI using advanced-generation ablation technologies.

This is a prespecified substudy of the CIRCA-DOSE trial, a prospective, randomized, multicenter study comparing PVI with contact force-guided radiofrequency ablation to secondary-generation cryoballoon ablation for paroxysmal AF. All study patients received an implantable cardiac monitor to allow continuous rhythm monitoring. ERAT was defined as any recurrent atrial tachyarrhythmia within the first 90 days after AF ablation.

ERAT occurred in 61% of the 346 patients at a median of 12 days (range 1-90 days) after ablation. ERAF was a significant predictor of late recurrence (60.1% with ER vs 25.9% without ER;p<0.001) and symptomatic atrial tachyarrhythmia (31.6% with ERAF vs. 6.7% without ERAF;p<0.001). Receiver operating curve analyses revealed a strong correlation between ERAF timing and burden and late recurrence. Multivariate analysis identified ER timing (HR 2.90; 95%CI1.41-5.95;p=0.004) and burden (HR 1.05 per 1% ER burden, 95%CI1.04-1.07;p<0.001) as strong independent predictors of late recurrence. The incidence rate, timing, burden, and prognostic significance of ER did not differ between the study groups.

Early recurrence of atrial tachyarrhythmia remains common after PVI despite use of advanced-generation ablation technologies. Early AF recurrence beyond 3 weeks after ablation is associated with increased risk of late recurrence.