Predictors of Short and Long Term Recurrences of Paroxysmal AF after Radiofrequency Ablation. Is Blanking Period Really Benign?

Allam, Lamyaa Elsayed; Moteleb, Ayman Morttada Abd El; Ghanem, Mazen T.

doi:10.4022/jafib.2012

Cited by 7 publications

(6 citation statements)

References 36 publications

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“…These results are comparable with previously published data, regarding the phased-radiofrequency technique [6,7,8,9,10,21], including the recently published initial results from the multicenter GOLD AF registry [22], in which complete acute PV isolation was achieved in 93.8% of patients. Interestingly, the relapse in the blanking period was the strongest independent predictor ( p < 0.0001) of AF recurrence in long-term follow-up, which stands in line with earlier observations regarding both RF [23,24,25] and cryoablation [26] and supports the opinion that blanking-period relapses are possible signs of early PV reconnection.…”

Section: Discussionsupporting

confidence: 89%

Atrial Fibrillation Ablation with Multipolar Phased-Radiofrequency Catheter: The Learning Curve Effect for Procedural Parameters, but not for the Long-Term Outcome

Główniak

Tarkowski

Wojewoda

et al. 2019

JCM

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Background: Pulmonary vein isolation (PVI) is a routine treatment in atrial fibrillation (AF). Single-shot techniques were introduced to simplify the procedure. We analyzed time-dependent changes in procedural parameters, acute success, complication rates, and long-term outcomes during our initial experience with multipolar phased-radiofrequency (RF) ablation. Methods and Results: The first 126 consecutive patients (98 male; age: 58.8 ± 8.7 years) who underwent PVI with phased-RF ablation at our center were included in the study. Procedural parameters, complication rate, acute success and 12-month efficacy were compared in the first, second and third group of 42 consecutive patients. In all patients, 516/526 PVs were effectively isolated (98.1%), with no differences between the tierces (p = 0.67). Procedure (169.8 vs. 132.9 vs. 105.8 min, p < 0.0001), fluoroscopy (32.9 vs. 24.3 vs. 14.1 min, p < 0.0001) and left atrial dwell (83.0 vs. 61.9 vs. 51.4 min, p < 0.0001) times were significantly reduced with experience in tierces 1–3, respectively. In the 12-month follow-up, 60.3% of patients were arrhythmia-free with no differences between the tierces (p = 0.88). In multivariate analysis, the relapse in the blanking period (p < 0.0001), time from AF diagnosis (p = 0.004) and left atrial diameter (p = 0.012) were the only independent predictors of AF recurrence. Conclusions: The learning curve effect was demonstrated in procedural parameters, but not in the complication rate nor the long-term success of PVI with phased-RF technique. The relapse in the blanking period was the strongest predictor of treatment failure in long-time observation.

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Section: Discussionsupporting

confidence: 89%

Atrial Fibrillation Ablation with Multipolar Phased-Radiofrequency Catheter: The Learning Curve Effect for Procedural Parameters, but not for the Long-Term Outcome

Główniak

Tarkowski

Wojewoda

et al. 2019

JCM

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“…The first 3 months after RFCA are known as a "benign or blanking period", with inflammatory changes and lesions of consolidations after RFCA, assumed as different causes of AFR. Recurrences are common and usually considered not relevant for long-term outcome: up to 50% of patients present AFR, and only half will develop later AFR [34]; on the other hand, absence of AFR predicts a successful outcome in the first year [37] and is associated with better long-term success rates [17,18].…”

Section: Comparison With Published Datamentioning

confidence: 99%

“…The intervention has favourable outcomes [12,13], but almost half of patients will have recurrences in the first year [1,8,14,15]. Early recurrences are frequently encountered [16], but do not always predict an unfavourable outcome [17][18][19]. After the first three months, atrial fibrillation recurrences (AFR) are associated with a higher recurrence risk in long-term monitoring [17,20,21].…”

Section: Introductionmentioning

confidence: 99%

“…Risk prediction scores have been designed; however, most of them rely on multiple parameters (clinical, electrical, echocardiography measurements, and type of intervention), are derived from inhomogeneous populations, and imply periodically in-hospital evaluations [22]. Atrial ectopics are triggers for AF episodes [1,18] and an increased number of supraventricular premature beats (SVPB) [23][24][25][26][27] correlates with a high risk of AF recurrences after ablation.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Atrial Fibrillation Recurrences after a First Radiofrequency Catheter Ablation Intervention for Paroxysmal Atrial Fibrillation—Experience of a Low Volume Ablation Centre

et al. 2021

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Background and Objectives: Atrial fibrillation recurrences (AFR) after radiofrequency catheter ablation (RFCA) are not uncommon, up to 65% of patients having relapses in the first year. However, current data are based mainly on studies from centres with a large volume of ablations, as they include technically inhomogeneous interventions, and populations with different types of AF. The aim of our study was to assess and stratify the risk at 6 and 12 months for AFR after a single RFCA, in patients with paroxysmal AF, in a centre with low volume activity. Materials and Methods: We enrolled 40 patients who underwent an initial RFCA, followed by continuous 48 h ECG monitoring at 1, 3, 6, and 12 months. Patients self-monitored their cardiac activity by random daily radial pulse palpation or in the presence of palpitations. Results: Ten independent predictors for late AFR were identified, and a 6-month risk score was computed using three of them: AFR duration in the first month, number of AFR between 1 and 3 months, and supraventricular ectopics per 24 h at 6 months. The score can explain 59% of the AFR (p = 0.001). A further 12-month assessment identified three independent predictors. The presence of AFR between 6–12 months is the most important of them (OR = 23.11, 95% CI = 3.87–137.83, p = 0.001), explaining 45% of AFR over 1 year. The risk scores at 6 and 12 months were internally validated. Conclusions: The 6-month score proved to be a useful tool in guiding further strategy for patients with a low risk, while a longer follow-up to 12 months may avoid unnecessary early reinterventions.

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“…Over the last decade, several studies have identified several major factors such as age, duration of AF, duration of AF paroxysm cycle, left and right atrium size (LA and RA), left ventricular ejection fraction (LVEF), as predictors of AF recurrence after the first successful RFA [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Atrial Fibrillation Recurrence After Radiofrequency Ablation in Patients With Chronic Heart Failure

et al. 2021

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The aim: To study the predictive power of demographic, hemodynamic and electrocardiographic factors for atrial fibrillation recurrence after radiofrequency ablation (RFA) in patients with chronic heart failure. Materials and methods: Study included 120 patients, aged 59,80±10,08 years old with chronic heart failure with preserved left ventricular ejection fraction who were undergo RFA due to atrial fibrillation (AF). A standard 12-lead electrocardiogram (ECG) was registered. Before the procedure the standard echocardiographic parameters were obtained. After 12 months, patients were divided into 2 groups: non-recurrence group and recurrence group. Results: As a result of prospective follow-up within 12 months AF recurrences were observed in 32 patients (27%), 88 patients remained non-recurrent (73%). The left atrium (LA) diameter and aortic root diameter were lager in the recurrence group (4,59±0,45 vs. 4,08±0,61 cm, p<0,001; 3,37±0,60 vs. 2,80±0,67 cm, p<0,001). The AF recurrence group before RFA had a significantly longer QTc interval than the non-recurrence group (387,23±2,31 vs. 341,22±8,91 ms, p<0,010). ROC curve analysis revealed LA diameter the most sensitive factor for AF recurrence after RFA. Conclusions: QTc duration before radiofrequency ablation and its prolongation after intervention are independent predictors of atrial fibrillation recurrence; left atrium diameter before ablation is a highly sensitive predictor in patients with chronic heart failure with preserved left ventricular ejection fraction.

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Predictors of Short and Long Term Recurrences of Paroxysmal AF after Radiofrequency Ablation. Is Blanking Period Really Benign?

Cited by 7 publications

References 36 publications

Atrial Fibrillation Ablation with Multipolar Phased-Radiofrequency Catheter: The Learning Curve Effect for Procedural Parameters, but not for the Long-Term Outcome

Atrial Fibrillation Ablation with Multipolar Phased-Radiofrequency Catheter: The Learning Curve Effect for Procedural Parameters, but not for the Long-Term Outcome

Predictors of Atrial Fibrillation Recurrences after a First Radiofrequency Catheter Ablation Intervention for Paroxysmal Atrial Fibrillation—Experience of a Low Volume Ablation Centre

Predictors of Atrial Fibrillation Recurrence After Radiofrequency Ablation in Patients With Chronic Heart Failure

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