Significance of early recurrence of atrial fibrillation after catheter ablation: a nationwide Danish cohort study

Hodges, Gethin W.; Bang, Casper N.; Torp‐Pedersen, Christian; Hansen, Morten Lock; Schjerning, A M; Hansen, Jim; Johannessen, Arne; Gislason, Gunnar; Pallisgaard, Jannik Langtved

doi:10.1007/s10840-020-00741-x

Cited by 13 publications

(21 citation statements)

References 16 publications

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“…Early recurrence after AF CA may be present in a significant number of patients within the first 3‐months after the procedure 13,18 . In the current study, the prevalence of ER was 14%, lower than reported in previous studies, which ranged from 16% to 65% 12 .…”

Section: Discussioncontrasting

confidence: 76%

“…Also referred to as the blanking period, this is conventionally defined as benign due to transient local inflammation, not being associated with an increased risk of long‐term recurrence nor requiring specific therapies or re‐intervention 15,29 . However, recent findings have suggested a relationship between blanking period recurrence and the risk of LR 17,18 . Kim et al demonstrated that ER was an independent risk factor for LR in patients who underwent first‐time RF ablation for AF 17 .…”

Section: Discussionmentioning

confidence: 99%

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Clinical relevance of the blanking period on late recurrence after catheter ablation of atrial fibrillation

Silva

Fernandes

et al. 2022

Cardiovasc electrophysiol

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Introduction Recurrence of atrial fibrillation (AF) within the blanking period after catheter ablation (CA) is traditionally classified as a transient and benign event. However, recent findings suggest that early recurrence (ER) is associated with late recurrence (LR), challenging the predefined “blanking period”. We aimed to determine the clinical and procedural predictors of ER and LR after CA and establish the risk of LR in patients who experience ER. Methods and Results Retrospective single‐centre study including all patients who underwent a first procedure of AF CA between 2017 and 2019. ER was defined as any recurrence of AF, atrial flutter or atrial tachycardia >30 s within 90 days after CA and LR as any recurrence after 90 days of CA. A total of 399 patients were included, 37% women, median age of 58 years [49‐66] and 77% had paroxysmal AF. Median follow‐up was 33 months (from 13 to 61). ER after CA was present in 14% of the patients, and LR was reported in 32%. Among patients who experienced ER, 84% also had LR (p < .001). Patients with ER had a higher prevalence of moderate/severe valvular heart disease, persistent AF, previous electrical cardioversion, a larger left atrium, higher coronary artery calcium score, and higher rates of intraprocedural electrical cardioversion and cardiac fibrosis on eletroanatomical mapping compared with patients without ER. After covariate adjustment, ER and female sex were defined as independent predictors of LR (hazard ratio [HR] 4.69; 95% confidence interval [CI], 2.99–7.35; p < .001 and HR 2.73; 95% CI, 1.47–5.10; p = .002, respectively). Conclusion The risk of LR after an index procedure of CA was significantly higher in patients with ER (five‐fold increased risk). These results support the imperative need to clarify the clinical role of the blanking period.

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Section: Discussioncontrasting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Clinical relevance of the blanking period on late recurrence after catheter ablation of atrial fibrillation

Silva

Fernandes

et al. 2022

Cardiovasc electrophysiol

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“…Similarly, Olshausen et al identified 46 days as the optimal BP duration based on last episode of ER in a cohort of 713 patients who had undergone de novo PVI. In a Danish registry of 7339 patients, Hodges et al demonstrated a significant graded increase of odds of LR according to the first occurrence of ER stratified by month (OR 2.08, 4.96, 5.14) [ 16 ]. While we also assessed ER according to first occurrence, we found divergent results.…”

Section: Discussionmentioning

confidence: 99%

Association between early recurrences of atrial tachyarrhythmias and long-term outcomes in patients after repeat atrial fibrillation ablation

Darden

Aldaas

Malladi

et al. 2021

J Interv Card Electrophysiol

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Purpose Early recurrence of atrial tachyarrhythmia (ER) is predictive of late recurrence of atrial tachyarrhythmia (LR) after first-time atrial fibrillation (AF) ablation, but the association in patients undergoing repeat AF ablation is unknown. We aim to determine the incidence and prognostic significance of ER after repeat ablation. Methods A total of 259 consecutive patients (mean age 64 years, 75.3% male) undergoing repeat AF ablation with complete follow-up data were included at a single institution from 2010 to 2015. ER and LR were defined as atrial tachyarrhythmia (AF, atrial flutter or atrial tachycardia) > 30 s within the 3-month blanking period (BP) and after the 3-month BP, respectively. Results ER occurred in 79/259 (30.5%), and LR occurred in 138/259 (53%) at a median follow-up of 1221 (IQR: 523–1712) days. Four-year freedom from LR was 22% and 56% in patients with and without ER, respectively (p < 0.001). After multivariate adjustment, ER was strongly associated with LR, cardioversion post BP, and repeat ablation, but not associated with hospitalization. Compared to those with no ER, there was a higher risk of LR when ER occurred within the first month of the BP [month 1: hazard ratio (HR) 2.32, confidence interval (CI) 1.57–3.74, p < 0.001; month 2: HR 2.01, CI 1.13–3.83, p = 0.02; month 3: HR 1.46, CI 0.5–3.36, p = 0.37], however the prediction of LR based on timing within the BP was poor (area under curve 0.64). Conclusion Following repeat AF ablation, ER is strongly associated with LR, cardioversion post BP, and repeat ablation.

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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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Significance of early recurrence of atrial fibrillation after catheter ablation: a nationwide Danish cohort study

Cited by 13 publications

References 16 publications

Clinical relevance of the blanking period on late recurrence after catheter ablation of atrial fibrillation

Clinical relevance of the blanking period on late recurrence after catheter ablation of atrial fibrillation

Association between early recurrences of atrial tachyarrhythmias and long-term outcomes in patients after repeat atrial fibrillation ablation

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

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