Related Experiment Video
Updated: Jul 3, 2025
Non-fluoroscopic Catheter Tracking for Fluoroscopy Reduction in Interventional Electrophysiology
Published on: May 26, 2015
Rethinking appropriate blanking period after atrial fibrillation ablation
Naoaki Onishi1, Akihira Suenaga1, Akinori Yoshida1
1Division of Cardiology, Japanese Red Cross Otsu Hospital, 1-1-35, Nagara, Otsu, Shiga, 520-8511, Japan.
Insights
Early recurrence of atrial fibrillation (AF) after catheter ablation (CA) strongly predicts late recurrence. A 30-day blanking period may be sufficient for assessing recurrence after CA, especially after repeat procedures.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Early recurrence (ER) after catheter ablation (CA) for atrial fibrillation (AF) is linked to late recurrence (LR).
- Limited data exists on ER and LR in repeat CA procedures.
- The optimal blanking period (BP) for assessing recurrence after CA is debated, with suggestions to shorten it from 90 to 30 days.
Purpose of the Study:
- To investigate the association between ER and LR in both first and second CA procedures for AF.
- To evaluate the effectiveness of a 30-day BP in predicting LR compared to the traditional 90-day BP.
Main Methods:
- Retrospective analysis of 511 patients undergoing their first CA and 116 patients undergoing a second CA for AF.
- Patients were categorized based on the timing of their last ER episode within the BP (0-30 days and 31-90 days).
- Hazard ratios for LR were calculated relative to patients with no ER.
Main Results:
- ER within 90 days significantly increased the risk of LR in both first and second CA procedures.
- The risk of LR was substantially higher when the last ER episode occurred between 31-90 days post-CA (HR 9.7 for first CA, HR 44.1 for second CA).
- This association was particularly pronounced after the second CA procedure.
Conclusions:
- ER is a strong predictor of LR following CA for AF.
- A shorter 30-day BP may be adequate for predicting LR, especially given improvements in pulmonary vein isolation (PVI) durability.
- The findings are particularly relevant for second CA procedures where PVI is expected to be more durable.
Background:
Early recurrence (ER) within a 90-day blanking period (BP) in catheter ablation (CA) for atrial fibrillation (AF) is a risk factor for late recurrence (LR) after 90 days postoperatively. However, few reports have examined them in the second CA and compared them to the first CA. Moreover, in recent years, there have been reports suggesting that BP should be reduced from 90 to 30 days. Therefore, the association between ER and LR in the first and the second CA was examined, and the validity of a 30-day BP was evaluated.
Methods:
A total of 511 consecutive patients undergoing the first CA and 116 of these patients undergoing the second CA for AF at a single institution from November 2016 to December 2020 were analyzed retrospectively.
Results:
When ER within a 90-day BP was divided into 0-30 days and 31-90 days according to the timing of the last ER episode, the hazard ratios on LR of them relative to no ER were 2.7 {95% confidence interval (CI) 1.7-4.2} and 9.7 (95% CI 6.6-14.3), respectively, for the first CA and 15.3 (95% CI 4.7-50.1) and 44.1 (95% CI 14.0-139.4), respectively, for the second CA.
Conclusions:
ER was strongly associated with LR, especially in patients with the last episode of ER more than 30 days after CA. This was pronounced in cases after the second CA, when PVI appeared to be completed. With the current improvement in PVI durability, BP may be acceptable for 30 days.
Related Concept Videos
01:28Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow...
01:30Cardiac Action Potential
The cardiac action potential process involves a series of phases characterized by the movement of ions across the cardiac cell membranes, leading to the depolarization and repolarization of the cardiac myocytes.
Ionic Basis of Cardiac Action Potentials
01:25Correlation between ECG and Cardiac Cycle
A cardiac action potential originates in the SA node and spreads throughout the atria and the AV node in approximately 0.03 seconds. This results in the P wave in an ECG and triggers atrial contraction. The action potential is then briefly slowed at the AV node, allowing the atria to contract and fill the ventricles with blood before...