Perspective:

It has long been recognized that early recurrences of AF (i.e., those occurring within 2-3 months after RFCA) may subside during long-term follow-up (3-12 months), and not recur in the very long follow-up (>12 months). It has been hypothesized that inflammation immediately after ablation may be responsible for this phenomenon; alternatively, the delayed effect of the ablation may be due to ‘lesion maturation.’ Prior studies have suggested that only about half of the early recurrence patients will manifest recurrence during long-term follow-up. For this reason, essentially all AF ablation studies have employed a blanking period of 2-3 months, when recurrences are not reflected in the reported success rates. The authors of the present analysis, spanning over 20 years of ablation experience, report that early recurrences may be more strongly associated with long-term outcomes than previously thought. This finding may have special significance given recent data suggesting that early ablation of AF (i.e., ablation soon after the diagnosis is made) may result in improved hard endpoints such as death from cardiovascular causes, stroke, or hospitalization with worsening of heart failure or acute coronary syndrome. It may also be that we should offer re-ablation to some of the patients with early recurrences.