Early Recurrence after Longstanding Persistent Atrial Fibrillation Ablation

Early recurrence (ER) of atrial fibrillation (AF) is common after ablation of longstanding persistent AF. However, optimal timing for repeat ablation has yet to be established.Two-hundred-four patients (mean age 62 ± 9 years) with longstanding persistent AF underwent catheter ablation including pulmonary vein (PV) isolation and substrate modification. ER defined as AF recurrence within 60 days, occurred in 115 patients (56.4%) 9 ± 1 days after the procedure. Analysis showed optimal blanking period to be 15 days. At 426 ± 224 days of follow-up, 30 of 50 (60.0%) patients with ER during the first 15 days (ER ≤ 15) and 13 of 65 (20.0%) patients with ER from the 16th to the 60th day (ER16-60) were free from protocol-defined treatment failure (PDTF) (P < 0.0001). In multivariate analysis, AF duration and LA diameter were independent predictors of ER16-60. Peak first ER was in the first 5 days, with a small maximum in the day 15~20 bin. The mean time to the first ER was longer in patients found to have PV reconnection during the repeat ablation than in those without (13 ± 14 versus 6 ± 7 days, P = 0.002).When adopting a blanking period of 15 days, fewer patients with an ER ≤ 15 had PDTF than those with an ER16-60. AF duration and LA diameter were predictive of an ER16-60.