The association between late-phase early recurrence within the blanking period after atrial fibrillation catheter ablation and long-term recurrence: Insights from a large-scale multicenter study

Onishi, Nobuyuki; Kaitani, Kazuaki; Nakagawa, Yoshihisa; Inoue, Koichi; Kobori, Atsushi; Nakazawa, Yuko; Ozawa, Tomoya; Kurotobi, Toshiya; Morishima, Itsuro; Miura, Fumiharu; Watanabe, Tetsuya; Masuda, Masaharu; Nio, Masaki; Fujimoto, Hajime; Nishida, Taku; Furukawa, Yoichi; Shirayama, Takeshi; Tanaka, Mariko; Okajima, Katsunori; Yao, Takeshi; Egami, Yasuyuki; Sato, Kazuhiro; Noda, Takashi; Miyamoto, Koji; Haruna, Tetsuya; Higashi, Youichirou; Itō, Makoto; Horie, Minoru; Kusano, Kengo; Shimizu, Wataru; Kamakura, Shiro; Shimizu, Yukiko; Hanazawa, Koji; Tamura, Toshihiro; Izumi, Chisato; Morimoto, Takeshi; Kimura, Takeshi; Shizuta, Satoshi

doi:10.1016/j.ijcard.2021.07.053

Cited by 24 publications

(19 citation statements)

References 17 publications

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“…They are a promising and potentially curative approach for the growing number of patients affected by these arrhythmias. Despite rapidly evolving technical and methodological improvements, the recurrence rates after catheter-based interventions in patients with AF are still up to 45% [ 3 , 4 , 5 , 6 , 7 ]. The frequency of recurrence depends on the classification of AF, the technique used and the extent of ablation, among other factors [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Cardioversion of Post-Ablation Atrial Tachyarrhythmia with Ibutilide and Amiodarone: A Registry-Based Cohort Study

Cacioppo

Schwameis

Schuetz

et al. 2022

IJERPH

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Patients with recurrence of atrial tachyarrhythmia after catheter ablation for atrial fibrillation or atrial flutter constitute a rapidly growing cohort, but study-driven treatment recommendations are lacking. The present study aimed to compare the cardioversion success of ibutilide and amiodarone in patients with post-ablation atrial tachyarrhythmia. We included all episodes of post-ablation atrial tachyarrhythmia in patients treated with either intravenous ibutilide or amiodarone at an academic emergency department from 2010 to 2018. The primary endpoint was the conversion to sinus rhythm. The conversion rates were stratified by arrhythmia type, and multivariable cluster-adjusted logistic regression was used to estimate the effect of ibutilide and amiodarone on cardioversion success, given as the odds ratio (OR) with 95% confidence intervals (95% CI). In total, 109 episodes of 72 patients were analyzed. The conversion rates were 37/49 (76%) for ibutilide and 16/60 (27%) for amiodarone. Compared to amiodarone, ibutilide was associated with higher odds of conversion (multivariable cluster-adjusted OR 5.6, 95% CI 1.3–24.3). The cardioversion success of ibutilide was the highest in atrial flutter (crude OR 19.5, 95% CI 3.4–112.5) and focal atrial tachycardia (crude OR 8.3, 95% CI 1.5–47.2), but it was less pronounced in atrial fibrillation (crude OR 4.5, 95% CI 1.2–17.2). Randomized trials are warranted to confirm our findings.

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Section: Introductionmentioning

confidence: 99%

Cardioversion of Post-Ablation Atrial Tachyarrhythmia with Ibutilide and Amiodarone: A Registry-Based Cohort Study

Cacioppo

Schwameis

Schuetz

et al. 2022

IJERPH

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“…However, many recent studies showed an association between early recurrence within 3 months of the blanking period and late recurrence. Therefore, the need to redefine the blanking period has been recently advocated 26–29 . Especially for cases of TBS, it is important to avoid underestimating the ATA recurrence after the ablation procedure because it is vital to determining whether PMI is necessary for patients with ATA recurrence after ablation.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the need to redefine the blanking period has been recently advocated. [26][27][28][29] Especially for cases of TBS, it is important to avoid underestimating the ATA recurrence after the ablation procedure because it is vital to determining whether PMI is necessary for patients with ATA recurrence after ablation. Four patients in the TBS group underwent a second ablation session between 2 and 3 months after the first ablation session.…”

Section: (A) ( B)mentioning

confidence: 99%

Impact of atrial fibrillation ablation on long‐term outcomes in patients with tachycardia‐bradycardia syndrome

Kataoka

Ejima

Yazaki

et al. 2022

Journal of Arrhythmia

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Background Reports of long‐term outcomes after atrial fibrillation (AF) ablation for tachycardia‐bradycardia syndrome (TBS) are limited. This study aimed to investigate the impact of radiofrequency catheter ablation (RFCA) on clinical outcomes in patients with TBS. Methods Among 1669 patients who underwent AF ablation between January 2010 and April 2020, we retrospectively enrolled 53 patients (62.3% males; age, 67.1 ± 7.0 years) who had been diagnosed with TBS before RFCA for paroxysmal AF (TBS group). After 1:2 propensity score‐matching based on age, gender, AF type, and left atrial dimension, 106 patients were assigned to the control group (non‐TBS group). The atrial tachyarrhythmia (ATA) recurrence rate and rate of avoidance of permanent pacemaker implantation (PMI) were examined. Results During a median follow‐up period of 37.7 months, the ATA recurrence rate after a single ablation procedure was significantly higher in the TBS group than in the non‐TBS group (51.0% vs. 38.5%; log‐rank p = .008); however, the ATA recurrence rate after the final ablation procedure did not significantly differ between groups. In the TBS group, the rate of PMI avoidance after AF ablation was 92.5%. A Cox‐regression multivariate analysis revealed that the presence of non‐pulmonary vein/superior vena cava premature atrial contractions (odds ratio, 3.38; 95% confidence interval, 1.49–7.66; p = .004) was an independent predictor of ATA recurrence in the TBS group. Conclusions Patients with TBS had higher ATA recurrence rates after the first ablation procedure compared to those without TBS. However, ATA recurrence after AF ablation did not necessarily result in PMI for TBS patients.

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“…Indeed, the 2017 Expert Consensus on CA for AF recommends avoiding reintervention during this period, since patients with early post-CA recurrence have been described to remain AF-free during long-term follow-up. 7,8 However, more recent studies have demonstrated that early AF might be strongly associated with late recurrences, especially when they occur later than 1-month post-RFCA 9 and CBCA. 10 These data have ultimately led to question this 90-day cutoff value.…”

Section: Introductionmentioning

confidence: 99%

Atrial fibrillation recurrences during the blanking period after catheter ablation with the laser balloon technique

Schiavone,

Gasperetti,

Martignani

et al. 2023

Cardiovasc electrophysiol

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IntroductionRegardless of the catheter ablation (CA) for atrial fibrillation (AF) strategy, the role of early recurrences during the blanking period (BP) is still unclear. Our aim was to evaluate atrial tachyarrhythmias (ATAs) recurrences during the BP after CA with the laser‐balloon (LB) technique.MethodsConsecutive patients undergoing LBCA were enrolled. Primary outcome of the study was the overall crude ATA recurrence rate during the BP. ATA recurrences after the BP and in‐hospital readmissions during the BP were deemed secondary outcomes.ResultsTwo hundred and twenty‐four patients underwent CA with the LB. Median age was 63.0 (55.5–69.5) years and 74.1% were males. 28.6% were persistent AF patients, and 34.8% of patients were followed up with a loop recorder. 15.6% of patients experienced at least an ATA recurrence during the BP. Male sex, chronic heart failure, persistent AF, and recurrences during the BP were found to be associated with long‐term ATA recurrences. Recurrences during the BP remained associated with the outcome of interest at multivariate analysis (hazard ratio [HR] = 12.393, 95% confidence interval [95% CI] = 3.699–41.865, p < .001). An association over time was found between early and late recurrences, with 73.7%, 45.5%, and 10.8% of patients presenting with recurrences at 1‐, 2‐, and 3‐month follow‐up being free from recurrences after the BP, respectively. 8.0% of patients were readmitted during the BP: 4.5% for AF electrical cardioversion, and 1.8% for CA of other atrial arrhythmias; no redo CA was performed.ConclusionAfter adjusting for confounders, ATA recurrences during the BP represent the most significant predictor of ATA recurrences after the BP, regardless of AF pattern.

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The association between late-phase early recurrence within the blanking period after atrial fibrillation catheter ablation and long-term recurrence: Insights from a large-scale multicenter study

Cited by 24 publications

References 17 publications

Cardioversion of Post-Ablation Atrial Tachyarrhythmia with Ibutilide and Amiodarone: A Registry-Based Cohort Study

Cardioversion of Post-Ablation Atrial Tachyarrhythmia with Ibutilide and Amiodarone: A Registry-Based Cohort Study

Impact of atrial fibrillation ablation on long‐term outcomes in patients with tachycardia‐bradycardia syndrome

Atrial fibrillation recurrences during the blanking period after catheter ablation with the laser balloon technique

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