Clinical significance of early recurrences of atrial fibrillation after pulmonary vein isolation

Abstract

Early recurrences of AF occur in approximately 35% of patients within two weeks after isolation of three to four PVs, and are associated with a lower long-term success rate than in patients without ERAF. However, approximately 30% of patients with ERAF have no further symptomatic AF during long-term follow-up. Therefore, temporary antiarrhythmic drug therapy may be more appropriate than early repeat ablation in patients with ERAF.

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…253,254,255 Although its precise mechanisms have not been fully elucidated, the possible causes include (1) a transient stimulatory effect of the tissue inflammatory response to the application of RF 256 ; (2) a transient imbalance of the ANS 257 ; and (3) a delayed effect of the application of RF, likely due to the maturation of the ablation lesion soon after the procedure. 258 A “blanking period” of 3 months after the procedure, during which reintervention should be avoided, is recommended because up to half of the patients with early recurrence remain AF-free during long-term follow-up.…”

“…253,329,436,684,932,935,970,971,972 Because these arrhythmias do not definitively indicate therapy failure over the long term (only half of these patients will manifest later recurrences), this period is also referred to as the blanking or therapy stabilization period. 935,973 It is also important to recognize that the later AF recurrences are observed during the blanking phase, the lower the chance of long-term success.…”

“…On the other hand, up to 60% of the patients experiencing this event within the first months postablation will not have any further arrhythmias during long-term follow-up. 253,436,970,971,994 Therefore, reablation is not recommended in an ERAF that might be a transient phenomenon. 2 …”

“…253,436,507,508,622,623, 624,625,630,870,871,995,996,997,998,999,1000,1001,1002 Most of these tachycardias originate in the LA, although RA cavotricuspid isthmus (CTI)-dependent flutters might also occur. Patients with a regular AT of new onset might complain of worsening symptoms due to a faster mean ventricular rate (frequently 2:1 ventricular response) than that during AF preablation.…”

“…Accordingly, suppressive antiarrhythmic agents are frequently prescribed for patients with AF recurrences during the first 1–3 months following ablation. 253,436,988,1010,1011 Because ATs can also occur shortly after ablation, negative dromotropic agents (beta or calcium channel blockers) are commonly continued for at least the first month after ablation. The impact of empirical AAD therapy for 6 weeks after AF ablation on the occurrence of AF was investigated in several randomized studies.…”