Early Recurrence of Atrial Tachyarrhythmias Following Radiofrequency Catheter Ablation of Atrial Fibrillation

Abstract

The use of blanking periods, the immediate period postablation during which transient tachyarrhythmia episodes are not considered recurrences, has been predicated on the assumption that not all early recurrences of atrial tachyarrhythmias (ERAT) will lead to later recurrences and, as such, does not necessarily represent treatment failure. While ERAT can be expected to occur in approximately 38% of patients within the first 3 months of atrial fibrillation (AF) ablation, only half of these patients will manifest later recurrences. Clinical features related to the patient's history of AF, the index ablation procedure, and particularities of the ERAT can help identify patients at higher risk of later recurrence in whom aggressive attempts to control rhythm, including early cardioversion and reintervention, may be justified.

Incidence and Significance of Early Recurrences of Atrial Fibrillation After Cryoballoon Ablation

“…Herein, we report a 52% incidence of ERAF <3 months of an index cryoballoon ablation procedure, which is consistent with nonrandomized observational studies after radiofrequency catheter ablation (16%-65%) as well as previous studies of cryoballoon ablation (44%). [3][4][5][6][7][8][9] Reassuringly, although ERAF was a relatively common occurrence after cryoballoon ablation, approximately half of these patients did not continue to have AF at longer-term follow-up, suggesting that transient periprocedural arrhythmogenicity is the predominant mechanism of ERAF in a subset of patients undergoing cryoballoon and RF ablation (44% with ERAF remained AF-free at 1 year, similar to the 46% rate reported after radiofrequency catheter ablation). [3][4][5][6][7][8] Nevertheless, a significant proportion of patients undergoing repeat cryoballoon ablation had early reconnection (52% of PVs).…”

“…[3][4][5][6][7][8] Although studies have retrospectively examined clinical variables associated with early and late arrhythmic recurrence after radiofrequency ablation, there is limited evidence regarding the prognostic significance of ERAF after cryoballoon ablation. 6,9 Moreover, the effect of early reablation (ie, within the 3-month blanking period) in patients with early recurrences after cryoballoon ablation remains unknown.…”

“…[3][4][5][6] Although relatively common, the long-term clinical significance of these early recurrences remains controversial because a significant number of patients remain free of late recurrent arrhythmias despite ERAF. [3][4][5][6][7][8] Although studies have retrospectively examined clinical variables associated with early and late arrhythmic recurrence after radiofrequency ablation, there is limited evidence regarding the prognostic significance of ERAF after cryoballoon ablation. 6,9 Moreover, the effect of early reablation (ie, within the 3-month blanking period) in patients with early recurrences after cryoballoon ablation remains unknown.…”

Redefining the Blanking Period After Catheter Ablation for Paroxysmal Atrial Fibrillation

“…In our study, 44.6% of patients experienced ER of symptomatic AT during the 3 months post ablation blanking period, consistent with prevalence rates between 16% and 65% in earlier studies. 1,2 The pooled average ER rate was 38% in trials that relied on sporadic ECG and Holter recordings instead of routine transtelephonic monitoring for detection. 2,7 It has been noted that the incidence of ER progressively decreases over time and is highest shortly after ablation.…”

“…1 Notably, during the first 3 months after ablation, a substantial proportion of patients experience early recurrences (ERs) of atrial tachyarrhythmias (ATs). [2][3][4][5] The relevance of ER to long-term recurrence risk is controversial; ERs are believed to often be because of transient local inflammatory states unassociated with the risk of later AF recurrence, and thus do not necessarily represent treatment failure. 3,4,6 It has, therefore, become common practice to use a periprocedural blanking period, during which recurrences are considered nonspecific and do not prompt reintervention.…”