Early recurrence of atrial tachyarrhythmia during the third month post-ablation strongly predicted late recurrence by 1 year (HR 9.64, P<0.0001), questioning the 90-day blanking period.
RCT (n=401)
Does the timing of early recurrence within the 3-month blanking period after catheter ablation for paroxysmal atrial fibrillation predict late recurrence?
Early recurrence of atrial tachyarrhythmia during the third month after catheter ablation for paroxysmal AF is highly predictive of late recurrence, challenging the utility of a strict 90-day blanking period.
Effect estimate: HR 9.64
p-value: p=<0.0001
BACKGROUND: Early recurrences (ERs) of atrial tachyarrhythmia are common after catheter ablation of atrial fibrillation. A 3-month blanking period is recommended by current guidelines. This study sought to investigate the significance of ER during the first 3 months post ablation in predicting late recurrences and determine whether it varies according to timing. METHODS AND RESULTS: A total of 401 patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation were followed for 12 months with transtelephonic monitoring in the ADVICE (Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) trial. Patients with atrial tachyarrhythmia ≥30 s within the 3-month blanking period were stratified according to the timing of ER. A total of 179 patients (44.6%) experienced their last episode of ER during the first (n=53), second (n=44), or third (n=82) month of the 3-month blanking period. One-year freedom from symptomatic atrial tachyarrhythmia was 77.2% in patients without ER compared with 62.6%, 36.4%, and 7.8% in patients with ER 1, 2, and 3 months post ablation, respectively (P90% of patients with ER during the third month post ablation experience late recurrence by 1 year. However, pending further study, repeat ablation before 90 days cannot be routinely advocated. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01058980.
Willems et al. (Mon,) conducted a rct in paroxysmal atrial fibrillation (n=401). Early recurrence of atrial tachyarrhythmia vs. No early recurrence was evaluated on One-year freedom from symptomatic atrial tachyarrhythmia (HR 9.64, p=<0.0001). Early recurrence of atrial tachyarrhythmia during the third month post-ablation strongly predicted late recurrence by 1 year (HR 9.64, P<0.0001), questioning the 90-day blanking period.