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Redefining the blanking period after pulsed field ablation in patients with atrial fibrillation
Sanghamitra Mohanty1, Prem Geeta Torlapati1, Michela Casella2
1Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
Insights
Early recurrence after pulsed-field ablation (PFA) for atrial fibrillation (AF) predicts late recurrence. The standard 3-month blanking period may need to be shortened to 1 month post-PFA.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Recurrence of atrial fibrillation (AF) within 3 months of radiofrequency ablation (RFA) is usually disregarded as a predictor of later recurrence.
- Pulsed-field ablation (PFA) is an emerging technique for AF treatment.
Purpose of the Study:
- To determine if early recurrence after PFA for AF is a risk factor for late recurrence.
- To evaluate the optimal duration of the blanking period following PFA.
Main Methods:
- Prospective follow-up of 337 consecutive patients undergoing PFA for AF for 1 year.
- Pulmonary vein isolation was performed in all patients; additional ablation was at operator discretion.
- Early recurrence was defined as atrial arrhythmia >30 seconds within the 3-month blanking period; late recurrence was any recurrence after 3 months.
Main Results:
- 15.7% of patients (53/337) experienced early recurrence.
- Recurrence in months 2 or 3 post-PFA was associated with a high likelihood of late recurrence (83.3% and 87% respectively).
- Patients with early recurrence in month 1 had a lower rate of late recurrence (30% required redo procedures).
Conclusions:
- Early recurrence in the second or third month after PFA for AF indicates a significant risk of late recurrence.
- The findings suggest that the blanking period after PFA for AF could potentially be redefined as 1 month.
Background:
Recurrence during the 3-month blanking period after radiofrequency ablation of atrial fibrillation (AF) is typically not considered as a predictor for late recurrence.
Objective:
We investigated the significance of early recurrence as a risk factor for late recurrence in patients with AF receiving pulsed-field ablation (PFA).
Methods:
Consecutive patients undergoing PFA were prospectively followed up for 1 year. All patients received isolation of pulmonary veins. Additional ablation procedures were performed per operator's discretion. After the procedure, all remained on their previously ineffective antiarrhythmic drugs (AADs) during the 2-month blanking period after which the AADs were discontinued. Early recurrence was defined as atrial arrhythmia of >30-second duration during the 3-month blanking period, and any recurrence beyond 3 months was considered as late recurrence.
Results:
A total of 337 patients undergoing PFA for AF were included. Early recurrence was recorded in 53 patients (15.7%): 10 in the first month, 12 in the second month, and 31 in the third month. Of the 10 patients having recurrence during the first month, 7 (70%) remained in sinus rhythm after cardioversion whereas 3 (30%) underwent a redo procedure because of late recurrence. At 1 year, all patients with recurrence in the second and third months experienced late recurrence; among these patients, 10 (83.3%) of 12 and 27 (87%) of 31 underwent a redo procedure and the remaining 6 patients were in sinus rhythm on AADs.
Conclusion:
In this consecutive series of patients with AF, early recurrence in the second or third month after the PFA procedure was associated with a high risk of late recurrence. Thus, blanking period could be redefined as 1 month after PFA.
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