Predictive value of atrial fibrillation during the postradiofrequency ablation blanking period

Calkins, Hugh; Gache, Larry; Frame, Diana; Boo, Lee Ming; Ghaly, Nader; Schilling, Richard J.; Deering, Thomas F.; Duytschaever, Mattias; Packer, Douglas L.

doi:10.1016/j.hrthm.2020.11.020

Cited by 32 publications

(24 citation statements)

References 28 publications

(20 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Though the definition of early versus late recurrence was different in this study—within 1 month and >1 to 6 months, respectively—there were still significantly more late recurrences among the ablation patients who had early recurrences versus those who did not (52% vs. 16%, HR 4.53, p = .0006) 17 . It is also interesting to point out that in our study, 87.7% of patients without early recurrence were free from 12‐month recurrence, which is consistent with a recent meta‐analysis reporting 89% of PAF patients without early recurrence were free of longer term recurrence (≥12 months) 20 …”

Section: Discussionsupporting

confidence: 89%

Predictors of clinical success after paroxysmal atrial fibrillation catheter ablation

Osorio

Hunter

Rajendra

et al. 2021

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Introduction Contact force (CF) guided ablation of paroxysmal atrial fibrillation (PAF) with stable catheter‐tissue contact optimizes clinical success and may increase an operator's ability to achieve pulmonary vein isolation (PVI) in a single encirclement. First pass PVI reduces procedure time but the relationship with long term clinical success is not well understood. This study evaluated patient characteristics and procedural details as predictors of 1‐year clinical success after PAF ablation, including first pass isolation. Methods Consecutive de novo PAF ablations were performed with a porous tip CF catheter in 2017 and 2018. All ablations used wide‐area circumferential ablation, with first pass isolation captured separately for the left and right pulmonary veins (PVs). CF was held between 10 and 20 g and the catheter was moved every 10–20 s. Radiofrequency energy was set at 40–45 W throughout the atrium. Patient characteristics and procedural details were tested for association with clinical success, defined as freedom from recurrent atrial tachyarrhythmia through 1 year. Results A total of 404 patients were included in the study. Clinical success at 1 year was 86.6%. Achieving first pass isolation on at least one ipsilateral PV pair was the most significant predictor of clinical success (p = .0126). After controlling for first pass isolation, only recurrence within the 90‐day blanking period was independently predictive (p = .0015). First pass isolation was not associated with early recurrence (p = .2454). Conclusion In a real‐world setting, first pass isolation was highly predictive of 12‐month clinical success after CF‐guided ablation in a PAF population.

show abstract

Section: Discussionsupporting

confidence: 89%

Predictors of clinical success after paroxysmal atrial fibrillation catheter ablation

Osorio

Hunter

Rajendra

et al. 2021

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…In the present study we found that age was the only significant predictor for procedural complications and that CAAP-AF and CHA 2 DS 2 -VASc were the only risk scores with significant, albeit poor, predictive value.. CAAP-AF was also the risk score with the highest AUC for prediction of recurrent AF, excluding BASE-AF 2 and MB-LATER, which both incorporate early AF recurrence as a risk factor. Previous research established that recurrent AF during the blanking period is a strong predictor of recurrent AF after the blanking period (26). Scores including early recurrence cannot be used for patient selection or counseling before the ablation procedure, although these scores could theoretically be useful to determine optimal follow-up strategies.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the predictive value of ten risk scores for outcomes of atrial fibrillation patients undergoing radiofrequency pulmonary vein isolation

Mulder

Kemme

Hopman

et al. 2021

International Journal of Cardiology

View full text Add to dashboard Cite

Background: A significant number of patients experience recurrent atrial fibrillation (AF) after ablation. Various risk scores have been described that may predict outcomes after AF ablation. In this study, we aimed to compare ten previously described risk scores with regard to their predictive value for post-ablation AF recurrence and procedural complications. Methods: A total of 482 AF patients (63% paroxysmal AF, 66% male, mean age 62 ± 9 years) undergoing initial radiofrequency pulmonary vein isolation (PVI) were included in the present analysis. Prior to ablation, all patients underwent both transthoracic echocardiography (TTE) and either cardiac CT imaging or CMR imaging. The following risk scores were calculated for each patient: APPLE, ATLAS, BASE-AF 2 , CAAP-AF, CHADS 2 , CHA 2 DS 2 -VASc, DR-FLASH, HATCH, LAGO and MB-LATER. Results: Median follow-up was 16 (12-31) months. AF recurrence after a 90-day blanking period was observed in 199 patients (41%), occurring after a median of 183 (124-360) days. AF recurrence was less frequent in paroxysmal AF patients compared to non-paroxysmal AF patients (34% vs. 54%, p < 0.001). Overall periprocedural complication rate was 6%. All scores, except the HATCH score, demonstrated statistically significant but poor predictive value for recurrent AF after ablation (area under curve [AUC] 0.553-0.669). CHA 2 DS 2 -VASc and CAAP-AF were the only risk scores with predictive value for procedural complications (AUC 0.616, p = 0.043; AUC 0.615, p = 0.044; respectively). Conclusions: Currently available risk scores perform poorly in predicting outcomes after AF ablation. These data suggest that the utility of these scores for clinical decision-making is limited.

show abstract

“…The significance of ERAT in patients with persistent AF is not well characterized, since prognostic value and characteristics of early recurrences are predominantly based on data from patients with paroxysmal AF [ 1 – 3 , 14 , 15 ]. A recent meta-analysis investigating the predictive value of ERAT after RFCA included data which originates from ~ 90% paroxysmal AF patients, while the persistent AF population remains clearly underrepresented [ 9 ]. In the paroxysmal AF cohort, there is increasing evidence that ERAT after PVI predicts LR [ 2 , 8 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, there is increasing evidence that ERAT following CA for paroxysmal AF is strongly associated with late recurrence (LR) beyond the blanking period [1,2,8]. In contrast, the prognostic significance of ERAT in patients with persistent and long-standing persistent AF is poorly defined, since the majority of data (~ 90%) originates from paroxysmal AF patient cohorts [9]. RFCA for persistent AF is associated with less favorable outcomes [7] and with higher ERAT rates [10][11][12] than for paroxysmal AF.…”

Section: Introductionmentioning

confidence: 99%

Early arrhythmia recurrence after catheter ablation for persistent atrial fibrillation: is it predictive for late recurrence?

et al. 2021

View full text Add to dashboard Cite

Background Early recurrence of atrial tachyarrhythmia (ERAT) is common after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF), but its clinical significance in patients with persistent AF remains unclear. We sought to determine the predictive value of ERAT for rhythm outcome after RFCA for persistent AF. Methods The study included 207 consecutive patients (mean age 66.4 ± 10.7 years, male 66.2%) with persistent and long-standing persistent AF undergoing de novo pulmonary vein isolation (± atrial substrate ablation). All patients remained off antiarrhythmic drugs. ERAT was defined as any atrial arrhythmia ≥ 30 s occurring within the first 30 days. Late recurrence (LR) was determined during follow-up visits scheduled 1, 3, 6 and 12 months post-ablation using 7-day Holter ECGs. Results ERAT occurred in 143/207 (69.1%) patients as AF (60%) or atrial tachycardia (40%) and was persistent in 82% of cases. During a median follow-up of 22.2 months, LR occurred significantly more often in patients with ERAT than in patients without ERAT (92.3 vs. 43.8%, P < 0.001). The only independent predictors for LR were ERAT (OR 16.8, 95% CI 6.184–45.797, P < 0.001) and intraprocedural termination to sinus rhythm (OR 0.052, 95% CI 0.003–0.851, P = 0.038). Extending the blanking period from 30 to 90 days did not impact LR rates. Conclusion ERAT following ablation of persistent AF is strongly associated with late arrhythmia recurrence, which challenges the assumption that ERAT represents merely a transient phenomenon. While limiting the blanking period to 30 days seems justified, the benefit of early re-ablations remains to be addressed in future studies. Graphic abstract

show abstract

Predictive value of atrial fibrillation during the postradiofrequency ablation blanking period

Cited by 32 publications

References 28 publications

Predictors of clinical success after paroxysmal atrial fibrillation catheter ablation

Predictors of clinical success after paroxysmal atrial fibrillation catheter ablation

Comparison of the predictive value of ten risk scores for outcomes of atrial fibrillation patients undergoing radiofrequency pulmonary vein isolation

Early arrhythmia recurrence after catheter ablation for persistent atrial fibrillation: is it predictive for late recurrence?

Contact Info

Product

Resources

About