Early arrhythmia recurrence after catheter ablation for persistent atrial fibrillation: is it predictive for late recurrence?
Blanking period
Catheter ablation
Early recurrence
Persistent atrial fibrillation
Journal
Clinical research in cardiology : official journal of the German Cardiac Society
ISSN: 1861-0692
Titre abrégé: Clin Res Cardiol
Pays: Germany
ID NLM: 101264123
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
24
01
2021
accepted:
30
08
2021
pubmed:
15
9
2021
medline:
15
2
2022
entrez:
14
9
2021
Statut:
ppublish
Résumé
Early recurrence of atrial tachyarrhythmia (ERAT) is common after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF), but its clinical significance in patients with persistent AF remains unclear. We sought to determine the predictive value of ERAT for rhythm outcome after RFCA for persistent AF. The study included 207 consecutive patients (mean age 66.4 ± 10.7 years, male 66.2%) with persistent and long-standing persistent AF undergoing de novo pulmonary vein isolation (± atrial substrate ablation). All patients remained off antiarrhythmic drugs. ERAT was defined as any atrial arrhythmia ≥ 30 s occurring within the first 30 days. Late recurrence (LR) was determined during follow-up visits scheduled 1, 3, 6 and 12 months post-ablation using 7-day Holter ECGs. ERAT occurred in 143/207 (69.1%) patients as AF (60%) or atrial tachycardia (40%) and was persistent in 82% of cases. During a median follow-up of 22.2 months, LR occurred significantly more often in patients with ERAT than in patients without ERAT (92.3 vs. 43.8%, P < 0.001). The only independent predictors for LR were ERAT (OR 16.8, 95% CI 6.184-45.797, P < 0.001) and intraprocedural termination to sinus rhythm (OR 0.052, 95% CI 0.003-0.851, P = 0.038). Extending the blanking period from 30 to 90 days did not impact LR rates. ERAT following ablation of persistent AF is strongly associated with late arrhythmia recurrence, which challenges the assumption that ERAT represents merely a transient phenomenon. While limiting the blanking period to 30 days seems justified, the benefit of early re-ablations remains to be addressed in future studies.
Sections du résumé
BACKGROUND
BACKGROUND
Early recurrence of atrial tachyarrhythmia (ERAT) is common after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF), but its clinical significance in patients with persistent AF remains unclear. We sought to determine the predictive value of ERAT for rhythm outcome after RFCA for persistent AF.
METHODS
METHODS
The study included 207 consecutive patients (mean age 66.4 ± 10.7 years, male 66.2%) with persistent and long-standing persistent AF undergoing de novo pulmonary vein isolation (± atrial substrate ablation). All patients remained off antiarrhythmic drugs. ERAT was defined as any atrial arrhythmia ≥ 30 s occurring within the first 30 days. Late recurrence (LR) was determined during follow-up visits scheduled 1, 3, 6 and 12 months post-ablation using 7-day Holter ECGs.
RESULTS
RESULTS
ERAT occurred in 143/207 (69.1%) patients as AF (60%) or atrial tachycardia (40%) and was persistent in 82% of cases. During a median follow-up of 22.2 months, LR occurred significantly more often in patients with ERAT than in patients without ERAT (92.3 vs. 43.8%, P < 0.001). The only independent predictors for LR were ERAT (OR 16.8, 95% CI 6.184-45.797, P < 0.001) and intraprocedural termination to sinus rhythm (OR 0.052, 95% CI 0.003-0.851, P = 0.038). Extending the blanking period from 30 to 90 days did not impact LR rates.
CONCLUSION
CONCLUSIONS
ERAT following ablation of persistent AF is strongly associated with late arrhythmia recurrence, which challenges the assumption that ERAT represents merely a transient phenomenon. While limiting the blanking period to 30 days seems justified, the benefit of early re-ablations remains to be addressed in future studies.
Identifiants
pubmed: 34519875
doi: 10.1007/s00392-021-01934-8
pii: 10.1007/s00392-021-01934-8
pmc: PMC8766394
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
85-95Informations de copyright
© 2021. The Author(s).
Références
J Cardiovasc Electrophysiol. 2009 Oct;20(10):1089-94
pubmed: 19549038
Eur Heart J. 2014 Dec 14;35(47):3356-64
pubmed: 25182250
Circ Arrhythm Electrophysiol. 2014 Feb;7(1):83-9
pubmed: 24446024
Circ Arrhythm Electrophysiol. 2016 Aug;9(8):
pubmed: 27516462
J Cardiovasc Electrophysiol. 2012 Dec;23(12):1295-301
pubmed: 22897339
Pacing Clin Electrophysiol. 2020 Oct;43(10):1156-1164
pubmed: 32895960
Pacing Clin Electrophysiol. 1996 Apr;19(4 Pt 1):484-9
pubmed: 8848397
JACC Clin Electrophysiol. 2017 Jun;3(6):568-576
pubmed: 29759429
Sci Rep. 2018 Jun 29;8(1):9875
pubmed: 29959347
Circ Arrhythm Electrophysiol. 2014 Feb;7(1):69-75
pubmed: 24446022
Eur Heart J. 2016 Feb 14;37(7):610-8
pubmed: 26417061
J Cardiovasc Electrophysiol. 2013 Apr;24(4):388-95
pubmed: 23252615
Circ Arrhythm Electrophysiol. 2015 Aug;8(4):846-52
pubmed: 26108982
Heart Rhythm. 2021 Mar;18(3):366-373
pubmed: 33242668
Heart Rhythm. 2008 May;5(5):679-85
pubmed: 18325850
J Cardiovasc Electrophysiol. 2009 Dec;20(12):1321-5
pubmed: 19602031
J Cardiovasc Electrophysiol. 2020 Mar;31(3):674-681
pubmed: 31984563
J Cardiovasc Electrophysiol. 1999 Mar;10(3):336-42
pubmed: 10210495
Pacing Clin Electrophysiol. 2012 Jan;35(1):106-16
pubmed: 22054110
Circulation. 1999 Nov 30;100(22):2237-43
pubmed: 10577997
J Cardiovasc Electrophysiol. 2008 Jun;19(6):599-605
pubmed: 18462321
Europace. 2018 Jan 1;20(1):e1-e160
pubmed: 29016840