October 21, 2013Cardiology JournalOpen Access

Does a blanking period after pulmonary vein isolation impact long-term results? Results after 55 months of follow-up

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Why the study?

Does antiarrhythmic prophylaxis prevent early and late AF recurrence in patients undergoing radiofrequency ablation for atrial fibrillation?

Structured PICO

Does antiarrhythmic prophylaxis prevent early and late AF recurrence in patients undergoing radiofrequency ablation for atrial fibrillation?

Population

210 consecutive patients who had undergone radiofrequency ablation (ARF) due to atrial fibrillation (AF).

Intervention

Antiarrhythmic prophylaxis during the first 2 months after ablation (amiodarone, sotalol, or last ineffective anti-arrhythmic drug).

Comparator

No anti-arrhythmic drug (AAD) during the first 2 months after ablation.

Outcome

Early AF recurrence during the first 2 months and late AF recurrence at long-term follow-up (mean 55 months).

Antiarrhythmic prophylaxis during the 2-month blanking period after AF ablation does not reduce early recurrences, but maintaining sinus rhythm during this period strongly predicts long-term success.

Implication

Antiarrhythmic prophylaxis need not be routine after AF ablation; confirms blanking-period sinus rhythm as a strong long-term prognostic factor.

Abstract

BACKGROUND: The aims of the study are 1) to assess antiarrhythmic prophylaxis efficacy during the first 2 months after radiofrequency ablation (ARF) due to AF; 2) to define risk factors for early AF recurrence (EAFR) after ARF; 3) to determine the long-term follow-up results and risk factors for late AF recurrence (LAFR). METHODS: A total number of 210 consecutive patients who had undergone ARF due to AF were analyzed. Patients were randomized into three groups: Group 1 (G1), without any anti-arrhythmic drug (AAD); Group 2 (G2), with amiodarone or sotalol; Group 3 (G3), with last ineffective AAD. The study was designed to analyze two periods: short-term observation, the first 2 months after ARF; and at least 2 years of long-term follow-up. RESULTS: After 2 months, clinical data were collected from 171 patients (123 males, mean age of 50.3 years; persistent AF in 19.8%; lone AF in 36.6%). Sinus rhythm (SR) was maintained in 84 (49.1%) patients; 35 (20.4%) patients presented with a single episode of AF, 39 (23%) patients experienced a reduction in number of AF episodes, and 13 (7.5%) patients showed no improvement. No predisposing factor for early recurrence was found. After a mean follow-up of 55 months, clinical data were collected in 137 patients, of which 47 (34%) maintained SR. Those more likely to sustain SR were: males (82.9% vs. 62.2%; p = 0.018), younger patients (44.8 ± 12.7 vs. 52.5 ± 9.9; p = 0.0001), patients with smaller left atrium diameter (4.05 ± ± 0.49 cm vs. 4.25 ± 0.51 cm; p = 0.04), and those without any AF recurrence during the first 2 months after ARF (78.7% vs. 35.6%; p < 0.0001). In the multivariable analysis, the independent risk factors for LAFR were hypertension (p < 0.001) and persistent AF (p = 0.014). CONCLUSIONS: Antiarrhythmic prophylaxis does not affect the number of AF recurrences during the first 2 months after ablation. SR maintenance during a blanking period after AF ablation is a positive prognostic factor in long-term follow-up. Persistent AF and hypertension are independent risk factors for late AF recurrence after pulmonary vein isolation.