Early recurrence during the blanking period and left atrial reverse remodeling after catheter ablation for non-paroxysmal atrial fibrillation

Abstract

Background Early recurrence of atrial tachyarrhythmia (ERAT) during a 90-day blanking period (BP) often occurs after atrial fibrillation (AF) ablation. Left atrial reverse remodeling (LARR), which is the reduction in LA volume (LAV), also occurs during the BP. Both ERAT and LARR are associated with late recurrence (LR, greater than 90 days after ablation). We investigated the association between ERAT and LARR following non-paroxysmal AF (NPAF) ablation. Methods We retrospectively reviewed 330 consecutive patients undergoing initial NPAF ablation (median follow-up: 4.0 years). Based on the timing of the final ERAT, we divided the patients into No-ERAT (N = 154, without ERAT), Early (N = 39, 0–7 days after ablation), Intermediate (N = 67, 8–30), and Late-ERAT (N = 70, 31–90) groups. We assessed the extent of LARR, defined as the percentage of decrease in LAV (%ΔLAV). The %ΔLAV cutoff value was determined by receiver operating characteristic analysis, and incorporated into a multivariate analysis to assess the association between ERAT and LARR. Results Late - ERAT was associated with LR (hazard ratio: 6.31, 95% confidence interval (CI): 4.21–9.47, p = 0.0001). The %ΔLAV in the Late-ERAT group was significantly smaller than the other groups ( p < 0.0001). The predictive power of %ΔLAV for LR was slight (AUC, 0.604; best cutoff, 18.8% decrease; p = 0.0011). In the multivariate logistic regression analysis, Late-ERAT was associated with poor LARR (%ΔLAV < 18.8% decrease) (odds ratio, 0.13; 95%CI, 0.06–0.27; p < 0.001), whereas Early- and Intermediate-ERAT did not show any correlation. Conclusions Late-ERAT was strongly associated with poor LARR after NPAF ablation. Both Late-ERAT and poor LARR might reflect a residual arrhythmogenic substrate causing LR.

Early arrhythmia recurrence after cryoballoon ablation in atrial fibrillation: A systematic review and meta‐analysis

“…The timing of an ER, rather than energy source or inflammatory response, seems to be of importance in predicting late outcomes. At least 15 studies of heterogeneous AF patients and varying, predominantly, RFA technologies have already suggested that thirdmonth versus first-month ER differ significantly in predicting arrhythmia-free survival, 12,28,[42][43][44][45][46][47][48][49][63][64][65][66][67] with the first being associated with approximately double the risk for LR compared to the latter. 12 The aforementioned evidence suggests that very ER (within the first few days) seems to be largely attributable to ablation-related myocardial injury and inflammation.…”

Clinical risk factors for decompensated heart failure after atrial fibrillation ablation

“…A previous study showed that 78% of early recurrence of AF occurred within 7 days after catheter ablation. 18 It is thought that early recurrence of AF often occurs at some point and contributes to late peri-procedural DHF.…”

Development and Validation of a Predictive Model Based on LASSO Regression: Predicting the Risk of Early Recurrence of Atrial Fibrillation after Radiofrequency Catheter Ablation

“…It has been proposed that early recurrence is associated with factors such as inflammatory damage during the ablation process [12], transient autonomic nervous system imbalances [13], and uneven scar tissue formation [14], but these associations lack specificity and are not often considered as actual clinical recurrences [15][16][17]. Nevertheless, many studies have demonstrated a connection between early and late recurrences after RFCA [18][19][20]. The concept of the "blank period" is still controversial, and early recurrence of AF should not be ignored [21,22].…”