Finerenone After Catheter Ablation to Reduce Atrial Fibrillation Recurrence

This is a concept‐generating study comprising three components: (1) a randomizedcontrolled trial testing whether adjunctive finerenone after catheter ablation reduces AFrecurrence compared with usual care; (2) cardiac CT to characterize the EAT phenotypebefore and after finerenone treatment; and (3) evaluation of whether serum UCP1 levelstrack brown/ epicardial adipose tissue remodeling and whether changes in UCP1 relate tooutcomes after AF ablation.All participants will undergo AF ablation with radiofrequency or pulsed field ablationfor pulmonary vein isolation (wide antral circumferential ablation recommended). Inpersistent AF, posterior wall isolation may be added at the physician's discretion. Afterconfirmation of entrance and exit block, participants will be randomized 1:1(computer‐generated sequence, stratified by left atrial diameter and AF type [paroxysmalvs nonparoxysmal]) to finerenone or usual care.Finerenone dosing: 10 mg once daily if eGFR 25‐<60 mL/min/1.73 m2; 20 mg once daily ifeGFR >=60 mL/min/1.73 m2; up‐titration at Week 4 where applicable if serum potassium<=4.8 mmol/L. Treatment duration: 12 months.Follow‐up visits occur at 2 weeks, 1, 3, 6, 9, and 12 months. Antiarrhythmic drugs arepermitted during the 90‐day blanking period with discontinuation encouraged thereafter.Rhythm monitoring includes 24‐hour Holter at baseline, 3, 6, and 12 months, andadditional monitoring for symptoms. Transthoracic echocardiography (including left atrialstrain and EAT thickness) is performed at baseline, 6, and 12 months; cardiac CT (EATvolume, mean attenuation, and density dispersion) at baseline and 12 months. Bloodbiomarkers (UCP1, NT‐proBNP, hsCRP, TGF‐beta, PINP, PIIINP) are measured at baseline, 1,6, and 12 months.