Early Rhythm Control and Catheter Ablation in Atrial Fibrillation: What’s New? (2023–2026)
Early Rhythm Control and Catheter Ablation in Atrial Fibrillation: What’s New? (2023–2026)
• Early rhythm control is now recommended for most patients with newly diagnosed AF to improve long-term cardiovascular outcomes.
• Catheter ablation is a Class I first-line rhythm-control therapy for selected symptomatic patients with paroxysmal AF and for patients with AF and HFrEF.
• EAST-AFNET 4 showed that rhythm control initiated within 1 year of AF diagnosis reduces major cardiovascular events versus usual care.
• A 2026 meta-analysis (22 RCTs) confirmed that catheter ablation is superior to antiarrhythmic drugs in preventing AF recurrence and may improve survival.
• 2026 evidence supports earlier catheter ablation, including first-line Pulsed Field Ablation (PFA), with greater efficacy and similar safety to antiarrhythmic drugs.
• Uninterrupted DOAC therapy remains the standard around AF ablation, with anticoagulation continued for ≥2 months and thereafter according to stroke risk.
• PFA is reshaping AF ablation and is likely to become the preferred energy source for AF, but it is not yet a universal replacement for all catheter ablation procedures.
* Catheter ablation remains beneficial across all AF stages, but the greatest success and benefit are achieved when performed early, before significant atrial remodeling.
Source : ACC (July 1, 2026) ; 2023 ACC/AHA/ACCP/HRS AF Guideline; 2024 ESC AF Guideline
https://www.acc.org/latest-in-cardiology/articles/2026/07/01/01/focus-on-ep
