Short-term vericiguat after catheter ablation for atrial fibrillation: a prospective patient preference–based clinical study

Vericiguat, an oral soluble guanylate cyclase stimulator, has shown beneficial effects on cardiac remodeling in heart failure; this study aimed to examine its potential role in reducing atrial fibrillation (AF) recurrence after ablation. This prospective, single-center, patient preference–based clinical study enrolled patients undergoing catheter ablation between February 2024 and January 2025. After ablation, participants chose to receive either standard post-ablation management alone or oral vericiguat for 12 weeks in addition to guideline-directed therapy. Follow-up was conducted during 3-month blanking period and at 6 and 12 months after ablation. Primary endpoint was atrial tachyarrhythmia recurrence. Secondary endpoints were changes in echocardiographic parameters, including LVEF, LAAPD and LVEDD. Thirty-nine patients completed follow-up and were included in primary endpoint analysis. Vericiguat did not significantly reduce atrial tachyarrhythmia recurrence during blanking period or at 6 months after ablation. However, at 12 months, recurrence was lower in vericiguat group. Within the vericiguat group, LAAPD and LVEDD decreased from baseline to 12 months; however, between-group comparisons of baseline-to-12-month changes did not show significant differences for LAAPD or LVEDD. Only right ventricular internal diameter change differed significantly between groups. In this exploratory prospective patient preference–based study, short-term vericiguat use after AF ablation was associated with a lower rate of late atrial tachyarrhythmia recurrence. However, given the small sample size, non-randomized allocation, baseline imbalance, and intermittent rhythm monitoring, these findings should be interpreted cautiously and require confirmation in larger randomized studies. This clinical study was registered in the Medical Research Registration and Filing Information System on February 2024. Registration number: MR-36-24-044536.