Among older adults with high blood pressure and atrial fibrillation, treatment with a combination of two blood pressure medications was associated with fewer recurring irregular heart rhythms after an ablation procedure compared with only one of the medications alone, according to new, independent, preliminary, late-breaking science presented today at the American Heart Association’s Scientific Sessions 2026. The meeting on Nov. 6-9 in Chicago is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.
According to the American Heart Association, atrial fibrillation, also called AFib, is an irregular heart rhythm that can cause symptoms such as a fast, fluttering or pounding heartbeat, shortness of breath, tiredness or weakness, and/or chest pain or difficulty exercising. AFib ablation is a procedure that uses heat or cold to treat small areas of heart tissue that are causing the abnormal electrical signals, helping the heart maintain a more normal rhythm. Although ablation treats the abnormal electrical activity responsible for AFib, it may not reverse underlying structural changes in the heart that may contribute to AFib. Over time, high blood pressure can place additional stress on the heart and contribute to enlargement, increased pressure and scarring of the heart muscle, and also narrowing of the arteries. These physical changes to the heart create an environment in which AFib can develop again even after an initially successful ablation.
“For many patients, AFib recurrence after an ablation can mean the return of symptoms, additional monitoring, medications or treatments to help restore a normal heart rhythm, and sometimes another ablation procedure,” said the study’s lead author Wei Zhang, M.D., Ph.D., a cardiologist in the department of cardiovascular medicine at the Shanghai Institute of Hypertension at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine in Shanghai, China. “Our goal was to find out whether treatment with a single or combination of blood pressure medications after ablation could affect the chance of AFib returning.”
At 12 months after an AFib ablation procedure, the sacubitril/valsartan combination was associated with a lower rate of documented recurrence of AFib or related atrial arrhythmias compared with patients in the valsartan-alone group. Documented atrial tachyarrhythmias recurrence occurred in 18% of participants in the sacubitril/valsartan group compared to 28.3% in the valsartan group. Systolic blood pressure measured at clinic visits fell by about 10 mm Hg in both groups, and there was no significant difference in the reduction in 24-hour ambulatory blood pressure between the two treatment groups.
“Our findings reinforce the idea that treating AFib does not end with the ablation procedure, and managing hypertension remains an important part of comprehensive AFib care. What was particularly interesting to us was that the difference in AFib recurrence was observed even though blood pressure reductions were similar between the two groups. This raises the possibility that after AFib ablation, the type of treatment used to lower blood pressure may be as important as how much blood pressure is lowered,” said Zhang. He added that the study findings should not be interpreted as suggesting that ablation alone or medication alone is sufficient to prevent AFib from recurring. “AFib is a complex condition, and successful long-term management requires both effective rhythm treatment and careful management of underlying cardiovascular risk factors, particularly hypertension,” Zhang said.
The randomized, controlled trial included 320 patients with both AFib and hypertension who received catheter ablation at three hospitals in China between February 2023 and January 2025. Participants were an average age of 68 years old; 41.2% were women; and 66.6% had paroxysmal AFib. After the ablation procedure, 161 patients were randomly assigned to start sacubitril/valsartan (100 mg once daily), and 159 patients were randomly assigned to start valsartan (80 mg once daily). Since all the participants had high blood pressure and required treatment, researchers used valsartan, an active blood pressure medication, as the comparison instead of a placebo.
The study had several limitations. It was an open-label trial, meaning that patients and treating physicians knew which medication group they had been assigned to; however, ECG-documented recurrence events were centrally adjudicated by an independent team blinded to information about which patients received which treatment. Heart rhythm monitoring was intermittent rather than continuous, so some brief or symptom-free AFib episodes may have been missed. In addition, the study focused on older adults with hypertension undergoing AFib ablation in China, so the findings may not necessarily apply to younger adults, people without hypertension or people living in other countries.
The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal. The study was supported by research grants from the National Natural Science Foundation of China, the Ministry of Science and Technology of China, Shanghai municipal research programs and the Clinical Research Program of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine.
