Flecainide Provides Comparable Rhythm Control Efficacy to Repeat Radiofrequency Ablation in Patients with Paroxysmal Atrial Fibrillation After Failed Cryoballoon Ablation.

Abstract

Class IC anti-arrhythmic drugs are primarily preferred for the rhythm control of atrial fibrillation (AF). In cases where ablation fails, the appropriate rhythm-control strategy is still unclear. In our study, we aimed to evaluate the efficacy of flecainide, propafenone, and radiofrequency ablation (RFA) as rhythm-control strategies in paroxysmal AF patients with failed cryoballoon ablation (CBA). In this cross-sectional study, 1120 patients who underwent CBA for paroxysmal AF between 2017 and 2024 were screened. Within this patient group, 230 patients with recurrent AF (≥3 months) after CBA were identified. A total of 120 patients (40 cases per treatment) who underwent rhythm control and received flecainide, propafenone, or RFA were finally included in the study. Study participants were then divided into three groups, receiving flecainide (group I), propafenone (group II), or RFA (group III). All patients were followed up for at least 1 year for AF recurrence, which was confirmed in 52 (43.2%) patients. The AF recurrence rates in groups I, II, and III were 35%, 75%, and 20%, respectively. Although the frequency of AF recurrence in groups I and III was statistically similar (P > .05), it was significantly lower in these groups than that in group II (P < .05). Group I patients were significantly more likely to use β-blockers than group II or III patients (P < .05). Patients with AF recurrence had a larger left atrial (LA) diameter and greater propafenone use. The number of patients who used flecainide and underwent RFA was lower in the AF recurrence group. In logistic regression analysis, LA diameter was found to be an independent predictor of AF recurrence (P = .002). In conclusion, based on the findings of our study, flecainide therapy can be used with an acceptable success rate in patients with recurrent AF after CBA.