Elsevier

International Journal of Cardiology

Volume 341, 15 October 2021, Pages 39-45
International Journal of Cardiology

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

https://doi.org/10.1016/j.ijcard.2021.07.053Get rights and content

Highlights

  • Early recurrences after radiofrequency catheter ablation for atrial fibrillation were associated with late recurrences.

  • The association was observed especially in patients with the first recurrence at >1 month within the 3-month blanking period.

  • This was especially true in patients with non-paroxysmal atrial fibrillation.

  • Therefore, they should undergo close observation in the follow-up.

Abstract

Background

The relationship between the timing of the first early recurrence and late recurrence after a single catheter ablation procedure for atrial fibrillation is controversial.

Methods

The Efficacy of Short-Term Use of Antiarrhythmic Drugs After Catheter Ablation for Atrial Fibrillation trial followed 2038 patients who underwent radiofrequency catheter ablation for atrial fibrillation.

Results

Of the patients, 907 (45%) had early recurrences within 90 days after the initial ablation. We divided these patients into two groups according to the timing of the first early recurrence episode, namely the ER1 group (early recurrence during the early phase; 0–30 days, n = 814) and ER2 group (early recurrence during the late phase; 31–90 days, n = 93). Three years after ablation, patients with early recurrences had a significantly lower event-free rate from late recurrences after a 90-day blanking period than patients without early recurrences (36.2% and 74.2%, respectively; log-rank, P < 0.0001). Three years after ablation, the event-free rate was significantly higher in the ER1 than the ER2 group (38.3% and 17.1%, respectively; log-rank, P < 0.0001). Moreover, the event-free rate at 3 years in the ER2 group was extremely low (5.6%) in patient with non-paroxysmal atrial fibrillation.

Conclusion

Early recurrences were strongly associated with late recurrences, especially in patients with the first recurrence episode at >1 month within the blanking period after a single ablation procedure. Therefore, these patients should undergo close observation during follow-up, when they had especially with non-paroxysmal atrial fibrillation.

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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