Two separate late-breaking studies presented at AHA 2026 shed light on ablation-related procedures or medical treatment of patients after atrial fibrillation (AFib) ablation.

In COAST-AF, simultaneously published in JAMA, researchers enrolled approximately 500 patients with persistent AFib of more than three months from 14 AFib ablation centers in Canada. Participants, of whom roughly 75% were men and an average age of 65 years, were randomized to either pulmonary vein isolation (PVI) plus ablation of atrial low-voltage areas (LVA) or PVI alone.

The primary outcome was atrial arrhythmia recurrence beyond 90 days. Researchers also assessed several secondary outcomes, including repeat ablation for AFib, atrial flutter, or atrial tachycardia, emergency visits or hospitalization, arrhythmia recurrence over 18 months, procedure duration, total ablation delivery time, AFib burden, and safety outcomes.

Based on overall findings, “adjunctive LVA ablation did not significantly reduce atrial arrhythmia recurrence in the overall population over a mean 21-month follow-up.” However, in discussing the findings, Pablo B. Nery, MD, et al., noted that among a prespecified subgroup analysis of 268 patients with LVA, the primary outcome of arrhythmia recurrence occurred in 68 of 138 patients (49.3%) assigned to PVI plus LVA ablation compared with 90 of 130 patients (69.2%) assigned to PVI alone. Arrhythmia recurrence over 18 months and AFib burden were also lower after PVI plus LVA ablation in this group.

In the SUPERIOR trial researchers in China assessed whether treatment with a combination of sacubitril and valsartan vs. valsartan alone resulted in fewer episodes of recurring AFib in adults (55 years and older) with hypertension after a catheter ablation.

Researchers randomized 320 patients, 41% of whom were women and nearly 67% who had paroxysmal AFib, to start sacubitril/valsartan (100 mg once daily) or valsartan (80 mg once daily) following catheter ablation. Overall results showed the combination of sacubitril/valsartan was associated with a lower rate of documented recurrence of AFib or related atrial arrhythmias compared with valsartan at 12 months (18% vs. 28%, respectively). In addition, blood pressure decreased by similar amounts (~10 mm Hg) in both groups.

“Our findings reinforce the idea that treating AFib does not end with the ablation procedure, and managing hypertension remains an important part of comprehensive AFib care,” said Wei Zhang, MD, PhD. “What was particularly interesting to us was that the difference in AFib recurrence was observed even though blood pressure reductions were similar between the two groups. This raises the possibility that after AFib ablation, the type of treatment used to lower blood pressure may be as important as how much blood pressure is lowered.”

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Prevention, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Hypertension

Keywords: AHA Annual Scientific Sessions, AHA26, Atrial Fibrillation, Atrial Flutter, Blood Pressure, Pulmonary Veins, Catheter Ablation, Hospitalization, Hypertension