Antiarrhythmic Drug Use in the Blanking Period After Re-Ablation and Recurrence in Paroxysmal Atrial Fibrillation

The effectiveness of continuous anti-arrhythmic drugs (AAD) therapy during the 3-month blanking period following repeat catheter ablation to prevent atrial fibrillation (AF) recurrence remains unclear. To evaluate the impact of continuous AAD therapy during the blanking period on AF recurrence in patients with paroxysmal atrial fibrillation (PAF) undergoing repeat ablation.

Patients with PAF who underwent repeat ablation from the China-AF Registry (2011-2022) were included in this study and categorized into two groups based on AAD use during the 3-month blanking period. The AF recurrence was defined as recurrent atrial tachyarrhythmias lasting for >30 s following the blanking period. Cox proportional hazard models were performed to assess the association between AAD status in the blanking period and AF recurrence at 12 months.

The study included 740 PAF patients (mean age 59.4 ± 10.6 years, 36.1% female) who underwent repeat ablation, with 289 patients in the on-AAD group and 451 in the off-AAD group. At 12 months post-ablation, 258 patients (34.9%) experienced AF recurrence. After adjusting for confounders, AAD use during the blanking period did not significantly associate with AF recurrence within 12 months after this period (HR = 1.07; 95% CI: 0.83-1.37; p = 0.599). Consistent results were found in different age, sex, body mass index, left atrial diameter, and CHA₂DS₂-VASc score subgroups.

There was no significant relationship between AAD therapy during the blanking period after repeat ablation and AF recurrence at 12 months in patients with PAF.