Beating Atrial Fibrillation Sinus Rhythm Wins Ablation Plus Lifestyle Change Is the New Gold Standard for AF.
Beating Atrial Fibrillation
Sinus Rhythm Wins
Ablation Plus Lifestyle Change Is the New Gold Standard for AF.
Published: July 24, 2025 – Medscape
Key Notes:
1. PRAGUE-25 Trial – Main Finding
• Compared catheter ablation (CA) vs. lifestyle modification + antiarrhythmic drugs in AF patients.
• At 12 months: 73% in CA group free of AF vs. 34.6% in the lifestyle+drug group.
• At 24 months: 55.6% (CA) vs. 24.7% (non-invasive group).
• Conclusion: CA is more effective at maintaining sinus rhythm (SR).
2. Experts Recommend a Combined Strategy
• Best outcomes come from ablation + risk factor control.
• Lifestyle change improves ablation durability.
3. Why Sinus Rhythm (SR) Matters
• SR linked to lower risk of:
• Stroke, death, bleeding, and cardiac arrest (CABANA trial).
• All-cause death reduced by 41% in patients maintaining SR.
4. Guidelines Have Shifted
• Recent updates (2023 AHA/ACC/HRS): Early rhythm control is now preferred.
• Rhythm control is especially important in younger patients and those with heart failure.
5. Treatment Should Be Personalized
• Not every patient needs ablation, but all should be informed.
• Antiarrhythmic drugs may help post-ablation, but relapse is common long-term.
• Lifestyle change is difficult but essential. GLP-1 agonists may support weight loss in AF patients.
Anticoagulation after AF Ablation
Even after successful ablation, most patients still need anticoagulants if their CHA₂DS₂-VASc score is high, because AF can silently return and stroke risk remains.
(ESC 2020 & EHRA 2023 Guidelines)