Recurrences in the Blanking Period and 12‐Month Success Rate by Continuous Cardiac Monitoring After Cryoablation of Paroxysmal and Non‐Paroxysmal Atrial Fibrillation

Pieragnoli, Paolo; Perini, Alessandro Paoletti; Ricciardi, Giuseppe; Checchi, Luca; Giomi, Andrea; Muraca, Iacopo; Mannucci, Letizia; Padeletti, Luigi

doi:10.1111/jce.13190

Cited by 25 publications

(30 citation statements)

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“…A recent study investigating the use of internal loop recorder for more precise determination of the success of PVI by CB ablation, in which 98.3% of the patients had undergone ablation using CB2, has reported that early recurrence occurred in 28.3% of patients ( n = 17), out of whom 14 (82.3%) had also late recurrences . In this study, late recurrence rate was 55% . These data suggest that subclinical recurrence rates are actually higher than clinically reported rates when compared to several single‐center‐based studies.…”

Section: Discussionmentioning

confidence: 42%

“…It is of note that the majority of studies evaluating the efficacy of CB ablation for AF have used 24‐h ECG Holter monitorization during follow‐up visits. A recent study investigating the use of internal loop recorder for more precise determination of the success of PVI by CB ablation, in which 98.3% of the patients had undergone ablation using CB2, has reported that early recurrence occurred in 28.3% of patients ( n = 17), out of whom 14 (82.3%) had also late recurrences . In this study, late recurrence rate was 55% .…”

Section: Discussionmentioning

confidence: 49%

“…Several predictors of AF recurrence following AF ablation using CB2 have been described in previous studies. These include AF type, duration of AF history, LA diameter, time to PVI, and early recurrence . Type and duration of AF as markers of atrial remodeling are well‐known predictors of AF recurrence, since longer exposure to arrhythmia results in more significant atrial structural and electrical remodeling, which may also explain the predictive role of LA diameter for AF recurrence.…”

Section: Discussionmentioning

confidence: 99%

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Long‐term outcomes of pulmonary vein isolation using second‐generation cryoballoon during atrial fibrillation ablation

Canpolat

Koçyiğit²,

Yalçın

et al. 2019

Pacing Clinical Electrophis

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Background: Currently available second-generation cryoballoon (CB2) is accepted as an effective and safe tool for pulmonary vein isolation (PVI). Although much more data exist about 1-year outcomes of CB2 ablation, data on long-term outcomes are scarce. Objective:We aimed to assess the long-term outcomes of PVI using CB2 in a large-scale symptomatic atrial fibrillation (AF) population at our tertiary referral center. Methods:In this nonrandomized prospective observational study, a total of 486 patients with paroxysmal (71%) or persistent (29%) AF who underwent index PVI using CB2 at our hospital between January 2013 and June 2017 were enrolled. Atrial tachyarrhythmia (ATa)-free survival was defined as the absence of AF, atrial flutter, or atrial tachycardia recurrence ≥30 s following a 3 months blanking period. Predictors of recurrence were evaluated by univariate and multivariate Cox proportional hazards regression models. Results:Acute procedural success rate was 99.8% (1898( /1902. Mean procedural and fluoroscopy time were 64.9 ± 9.2 and 12.1 ± 2.6, respectively. At median 39 (interquartile range: 26-56) months follow-up, ATa-free survival was 78.6% after a single procedure (280/345 [81.2%] for paroxysmal AF vs. 102/141 [72.3%] for persistent AF, P = .019) and 84.4% after a mean 1.48 ± 0.42 ablations. Cox regression analysis showed that left atrium diameter, duration of AF history, and early ATa recurrence were found as the independent predictors of late recurrence.Phrenic nerve palsy was observed in 17 (3.5%) patients. Conclusions:CB2-based PVI is effective to maintain sinus rhythm in a significant proportion of paroxysmal and persistent AF patients with an acceptable complication rate at long-term follow-up. K E Y W O R D S atrial fibrillation, complication, cryoballoon, recurrence 1 INTRODUCTION As pulmonary vein (PV) isolation (PVI) is accepted as the cornerstone of all atrial fibrillation (AF) ablation procedures, recent expert consen-sus document recommends to isolate PVs at first either using point-bypoint radiofrequency (RF) or cryoballoon (CB) ablation in all patients, including paroxysmal and nonparoxysmal AF. 1 CB technology has been shown to be as effective as RF technique for AF ablation. 2 910

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Section: Discussionmentioning

confidence: 42%

Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

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Long‐term outcomes of pulmonary vein isolation using second‐generation cryoballoon during atrial fibrillation ablation

Canpolat

Koçyiğit²,

Yalçın

et al. 2019

Pacing Clinical Electrophis

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“…Mugnai et al found that ER was independently associated with LR (HR = 6.79) [ 22 ]. Moreover, Pieragnoli et al demonstrated that 82.3% of patients with ER after RFCA experienced LR, whereas only 30.2% of patients without ER experienced LR [ 23 ]. Yalin et al found that arrhythmia recurrence during the blanking period was an independent predictor of long-term AF recurrence, although the treatment was not RFCA but second-generation cryoballoon [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Amiodarone and Propafenone in Blanking Period after Radiofrequency Catheter Ablation in Patients with Atrial Fibrillation: A Propensity Score-Matched Study

Huang

Lin

Gong

et al. 2020

BioMed Research International

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Background. Amiodarone and propafenone are commonly used to maintain sinus rhythm in patients with atrial fibrillation (AF). However, it is not known which one is better in reducing early recurrence (ER) during the blanking period (the first three months after catheter ablation). Objective. To compare the efficacy and safety of amiodarone and propafenone in reducing ER during the blanking period after radiofrequency catheter ablation (RFCA) in AF patients. Materials and Methods. A total of 694 patients who underwent their first RFCA between May 2014 and May 2018 were enrolled in this retrospective study. Subsequently, 202 patients were excluded according to the exclusion criteria. The remaining 492 patients were divided into two groups based on the choice of antiarrhythmic drugs (AADs) (amiodarone or propafenone) in the blanking period. The primary outcomes were incidence of ER and AAD-associated adverse effects during the blanking period after RFCA. Propensity score matching (PSM) analyses were used to compare the outcomes of the two groups while controlling for confounders. Results. Among the 492 patients who took AADs in the blanking period (187 amiodarone and 305 propafenone), PSM selected 135 unique pairs of patients with similar characteristics. Amiodarone was associated with a lower ER incidence rate (23.7% versus 48.9%, p<0.001) and a similar rate of AAD-associated adverse effects (2.1% versus 1.5%, p=0.652). Treatment with amiodarone in the blanking period was significantly associated with a lower ER incidence rate compared to treatment with propafenone (HR=0.416, 95% CI 0.272–0.637, p<0.001). Conclusions. Compared with propafenone, amiodarone was associated with a lower ER incidence rate, and they had similar rates of AAD-associated adverse effects. Treatment with amiodarone in the blanking period was shown to be more effective in reducing ER than propafenone.

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“…In this issue of JCE, Pieragnoli et al add to this evolving literature by reporting their experience with recurrences during the blanking period after cryoballoon ablation for AF. 11 They followed a small patient population of both paroxysmal and nonparoxysmal AF patients.…”

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confidence: 99%

What happens during the blanking period does not stay in the blanking period

Verma

Knight

2017

Cardiovasc electrophysiol

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K E Y W O R D S : clinical: catheter ablation-atrial fibrillationCatheter ablation is increasingly used to treat symptomatic, drugrefractory atrial fibrillation (AF). Within the first 3 months after ablation, early recurrences of AF and atrial tachycardia (AT) are common and felt to have uncertain, long-term significance. Thought to be due to the inflammatory response from ablation, these recurrences have long been regarded as nonspecific without need for further intervention.This 3-month, periprocedural "blanking period" is recommended by the Expert Consensus Statement on Catheter and Surgical Ablation of AF when determining procedural efficacy. In the absence of symptoms, routine monitoring is not recommended during this timeframe. 1 This recommendation has not only been adopted into routine clinical practice, but is also a standard feature of clinical trial design. Increasingly, reports have called into question the length of the blanking period 2 and called attention to the potential prognostic significance of recurrences during this timeframe. 3,4 It is also important to recognize the negative impact that recurrent AF and AT often have on the patient's experience with ablation and the need to capture these outcomes in clinical trials.Immediate recurrences after ablation are likely due to the acute inflammatory response caused by myocardial tissue damage from ablation. Inflammatory markers, however, appear only to be significantly increased for only the first week after the procedure 5 and are an unlikely explanation for all recurrences in the first 3 months. Tissue edema appears to resolve within 4 weeks in both animal models and humans. 6,7 In addition, many reports indicate that the most likely timeframe to develop early recurrences is the first 2 weeks after ablation with a progressive decrease in incidence thereafter. 2,8 There appears to be an inverse relationship between the time to early recurrence and late-term atrial tachyarrhythmia outcomes. Patients with a recurrence >1 month postablation fare much worse than those with recurrences within the first month. 4,9,10 B.P. Knight reports participation on a research grant supported by Medtronic, for whom he also reports serving as a consultant or on the advisory board.In this issue of JCE, Pieragnoli et al. add to this evolving literature by reporting their experience with recurrences during the blanking period after cryoballoon ablation for AF. 11 They followed a small patient population of both paroxysmal and nonparoxysmal AF patients.With implantable loop recorders (ILRs), they reported the rates of early and late AF recurrence as well as the prognostic value of early recurrences. They report that >80% of patients with early recurrence went on to develop late recurrences, a likelihood ratio of 5.7. In a multivariate analysis, the presence of nonparoxysmal AF and early recurrence were independent predictors of late recurrence.The authors should be commended on their contribution as it has both confirmed other reports but also served as an important add...

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Recurrences in the Blanking Period and 12‐Month Success Rate by Continuous Cardiac Monitoring After Cryoablation of Paroxysmal and Non‐Paroxysmal Atrial Fibrillation

Abstract: CB-PVI for paroxysmal AF shows a 12-month success rate of 76.5% after one single procedure, as assessed by continuous cardiac rhythm monitoring. Within-blanking recurrences predict the ablation failure in more than 80% of patients.

Cited by 25 publications

References 40 publications

Long‐term outcomes of pulmonary vein isolation using second‐generation cryoballoon during atrial fibrillation ablation

Long‐term outcomes of pulmonary vein isolation using second‐generation cryoballoon during atrial fibrillation ablation

Comparison of Amiodarone and Propafenone in Blanking Period after Radiofrequency Catheter Ablation in Patients with Atrial Fibrillation: A Propensity Score-Matched Study

What happens during the blanking period does not stay in the blanking period

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