Atrial fibrillation is a serious risk to human health and can lead to high rates of disability and death. For patients with atrial fibrillation, a number of studies have shown that catheter radiofrequency ablation is significantly more effective than antiarrhythmic drug therapy. But what should be the choice for patients who have recurrence of radiofrequency ablation? Should they choose to have another ablation procedure or continue with oral AAD therapy? Is there a difference in outcome between the two? A study published by Pokushalov E et al in Circulation AE answered this question. This prospective, randomized, controlled study enrolled 154 patients with paroxysmal atrial fibrillation (PAF) who had recurrent symptomatic AF after initial ablation and who had indications for reablation and drug therapy. After a 3-month blanking period, 77 patients each underwent early reablation with pulmonary vein isolation (PVI, with routine pulmonary vein patch ablation and isolation of the mitral isthmus line or parietal wall line if left atrial flutter was present The patients were treated with either early re-isolation (PVI, with routine pulmonary vein patch ablation, mitral isthmus line or parietal line ablation in case of left atrial flutter, tricuspid isthmus ablation in case of documented typical atrial flutter) or antiarrhythmic drugs (AAD) (propafenone, 450C900 mg/d; flecainide, 200C400 mg/d; sotalol, 160C320 mg/d), and were followed for 3 years with the most stringent implantable rhythm monitor (ILR) available. 3-year follow-up. For patients without structural heart disease, class 1C AAD was the drug of choice, and sotalol was preferred for patients with coronary artery disease. However, the study did not define the duration of drug administration and did not select amiodarone, which has a relatively definite effect, for treatment. At the end of 36 months of follow-up, 61 patients (79%) in the drug group and 19 patients (25%) in the reablation group showed respective AF% progression (p>0.01, Figure 2); AF% progression was significantly higher in the drug group than in the reablation group (18.8±11.4% vs. 5.6±9.5%, p>0.01). The incidence of AF-free was several times higher in the re-ablation group than in the drug treatment group (58% versus 12%; p<0.01), and 45 patients (58%) in the re-ablation group were free of AF or atrial tachycardia recurrence after ablation without AAD, compared with only 9 patients (12%) in the drug treatment group (Figure 3). In addition, patients in the drug group were more likely to progress to persistent AF compared with the re-ablation group (18 vs 3 cases, 23% versus 4% ; P<0.01). In the drug group, 43 patients were crossed over to the ablation group for a second procedure due to persistent AF episodes that failed to respond to drug therapy, and 2 patients underwent a third procedure. In the re-ablation group, 21 patients required AAD treatment for AF recurrence, and 11 patients underwent a third procedure. Thus, in patients who failed the first ablation, reablation therapy was more effective than drug therapy alone in reducing the progression and morbidity of atrial fibrillation. Thus, the effectiveness of the reablation procedure was determined.