The blanking period after atrial fibrillation ablation: an European Heart Rhythm Association survey on contemporary definition and management

Abstract

The use of a blanking period (BP) after an atrial fibrillation (AF) ablation procedure is a common practice, but recent data questions the benign nature of early recurrences of atrial tachyarrhythmias (ERATs). A physician-based survey was carried out by the European Heart Rhythm Association (EHRA) to investigate the current definition and applicability of BP and ERAT management. An online questionnaire was sent to clinical and interventional electrophysiologists. A total of 436 respondents (88% interventional electrophysiologists) reported observing ERATs in 25% (interquartile range 15–35) of patients, less commonly in paroxysmal AF (PAF) compared with persistent AF (persAF). The median reported duration of BP used by respondents was 90 days, with 22% preferring a shorter BP duration for PAF patients compared with persAF. Half of the patients with ERATs are expected to also experience late recurrences (LR). Isolated episodes of ERATs are treated conservatively by 99% of the respondents, but repeat ablation during the BP is preferred by 20% of electrophysiologists for multiple ERATs and by 16% in patients with organized atrial tachyarrhythmias. In conclusion, ERATs are commonly observed after AF ablation, particularly in persAF patients, and are perceived as predictors of LR by half of the respondents. A general adherence to a 90-day BP duration was observed. During this time period, ERAT is mainly treated conservatively, but repeat ablation during the BP is occasionally offered to patients with multiple ERATs and those with organized atrial tachyarrhythmias.

Early recurrences predict late therapy failure after pulsed field ablation of atrial fibrillation

“…Several studies questioned the true benign nature of early recurrences 4,31,32 . These results were not incorporated in the consensus statement and many physicians still adhere to the 90 days BP 33 . According to our finding, ERAT seems to be a marker for LR also after PFA‐PVI.…”

A call for shorter blanking period, time to get off the ground

“…Although, most electrophysiologists reckon that half of patients with ER will ultimately suffer LR and 25% already employ a shorter BP for paroxysmal AF, only 1% utilizes an implantable loop recorder to detect asymptomatic ER and 30% opt for no screening at all. 1 We also reported that asymptomatic ER detection is low after cryoablation (6/27 included studies in our meta-analysis) and ER is rarely addressed as a primary endpoint (11/27 studies). 3 …”

“…Bordignon et al . 1 are to be congratulated for conducting this survey. Indeed, blanking period (BP) is a debated topic, and this well-structured study featuring a representative sample of experienced electrophysiologists underscores both the clinical significance and the understandable management uncertainties regarding early recurrence (ER).…”

Don’t lose the ground—the EHRA blanking period survey

“…We thank Dr. Papathanasiou and colleagues for the interest 1 in the survey realized by the EHRA scientific initiative committee. 2 Aim of this study was to highlight the different perception and management of early recurrences (ER) among European electrophysiologists: the findings confirmed how ERs are widely recognized as a predictor of late recurrences (LR), and showed how, in the lack of a clear evidence and consensus, the management of ER varies among different operators.…”