Atrial Fibrillation Recurrence After Catheter Ablation: The Puzzle We Have and the Pieces We Need.

Atrial fibrillation (Afib) recurrence following catheter ablation (CA) remains a significant challenge within the electrophysiology community, potentially driven by complex mechanisms and diverse patient characteristics. Although multiple predictors of recurrence have been investigated, only a limited number have been consistently validated across studies, suggesting uncertainty in their predictive reliability. Advances in ablation techniques, such as pulsed-field ablation, may offer improved outcomes compared to traditional methods, though their long-term efficacy awaits further confirmation. Aggressive management of modifiable risk factors, alongside selective pharmacotherapies, appears to enhance ablation success, yet optimal strategies remain under exploration. Post-recurrence interventions, such as timely cardioversion or early reablation, could improve rhythm control, but their benefits depend on refined patient selection and timing. Emerging technologies, including artificial intelligence and advanced mapping, hold potential to refine risk stratification and procedural precision, pending robust validation. Comprehensive approaches integrating lifestyle interventions, procedural innovations, and individualized care seem essential for optimizing Afib management. Addressing these gaps may provide the critical pieces needed to solve the puzzle of Afib recurrence after CA.