The association between late-phase early recurrence within the blanking period after atrial fibrillation catheter ablation and long-term recurrence: Insights from a large-scale multicenter study
Section snippets
Background
In catheter ablation (CA) of atrial fibrillation (AF), early recurrences of atrial tachyarrhythmias (ERs) within a blanking period may be unrelated to late recurrences (LRs) during follow-up [1,2]. Therefore, the expert consensus recommends a 3-month post-CA blanking period when evaluating LR incidence [3]. However, several studies have reported that an ER is strongly associated with LR [2,4]. Thus, ER's role in predicting the long-term recurrence of AF remains controversial.
The Efficacy of
Study population
This study analyzed 2038 patients who underwent an AF ablation from the EAST-AF trial. The details of the EAST-AF trial were published previously [5]. Briefly, the EAST-AF study was a prospective, randomized clinical trial. It investigated whether the 90-day use of AADs following AF ablation could reduce the incidence of an early arrhythmia recurrence and promote reverse remodeling of the left atrium (LA), leading to improved long-term clinical outcomes. However, the advantage of ER reduction
ERs during the blanking period
This study followed-up 2038 patients for 3 years. Of the patients, 1131 (55%) and 907 (45%) were without and with ERs, respectively. ERs occurred within 1 month (ER1) and > 1 month during the blanking period (ER2) in 814 and 93 patients, respectively.
Baseline clinical characteristics
Table 1 shows the baseline clinical characteristics of the patients with and without ER. There was a significant difference in age, AF history, non-PAF type, and LA diameter between the patients with and without ERs.
The patients with ER1 were
Main findings
The present study revealed that patients with ERs later in the blanking period (31–90 days) had a significantly higher risk of long-term recurrence compared to those experiencing ERs with in the first month (0–30 days). Furthermore, this finding was greater in non-PAF patients than that in PAF.
The optimal cutoff interval of the blanking period
The use of the 90-day blanking period was predicted on the assumption that not all ERs would lead to LRs [3]. However, the optimal cutoff interval of the blanking period remains controversial [2,4].
Limitations
This study had several limitations. First, this study used standard noninvasive follow-up methods, not invasive methods (e.g., insertable cardiac monitor). Therefore, detecting AF recurrences after catheter ablation, particularly in cases with asymptomatic AF, was difficult. Second, the first ER episode within the blanking period was examined, but the second, third, and last ER episodes were not examined. Therefore, the ER1 group included patients with early-phase ER, followed by late-phase ER.
Conclusions
ERs are associated with LRs, especially in the patients with a first episode of a recurrence during the late phase within the blanking period after a single ablation. Therefore, the patients with ERs >1 month during the blanking period needed close observation in the follow-up, especially in non-PAF patients.
Funding
This study was supported by the Research Institute for Production Development in Kyoto, Japan.
Grants
None.
Declaration of competing interest
None declared.
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