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Three-Month Blanking Period After A-Fib Ablation Should Be Shortened, Researchers Say
Two studies show recurrence within blanking period is associated with increased risk for recurrence in long term
MONDAY, April 22, 2024 (HealthDay News) -- The three-month blanking period (BP) after atrial fibrillation (AF) ablation, when recurrences are not thought to predict long-term outcome, is called into question in two studies recently published in Heart Rhythm.
Dan L. Musat, M.D., from the Valley Hospital in Ridgewood, New Jersey, and colleagues enrolled 210 consecutive patients who had cryoballoon pulmonary vein isolation and an implantable loop recorder and examined the time of last confirmed AF episode within the BP. The researchers found that 48 percent of patients had AF recurrence after the three-month BP at 160 ± 86 days. During long-term follow-up, significantly greater AF recurrence was seen for those with recurrent AF and AF burden >0 percent 30 days after ablation compared with those with no AF in the BP.
Benjamin De Becker, M.D., from AZ Sint Jan Bruges in Belgium, and colleagues examined the relationship between early recurrence of atrial tachyarrhythmia (ERAT) and late recurrence based on insertable cardiac monitor data in 165 patients who underwent radiofrequency ablation for paroxysmal or persistent AF. The researchers found that 41 patients experienced late recurrence during the one-year follow-up period. Patients experiencing ERAT had a higher risk for late recurrence (hazard ratio, 6.2), with negative and positive predictive values of 90.5 and 45.7 percent, respectively. Compared with those without recurrence, patients with late recurrence had a significantly higher burden of AF during the BP (7.9 versus 0.0 percent).
"Rather than determining the significance of arrhythmia recurrences based on whether they occur before or after a set time point, a contextual assessment should be made that takes into account their frequency, duration, and clinical impact," Sohaib Virk, B.Med./M.D., and Jonathan M. Kalman, M.B.B.S., Ph.D., from the Royal Melbourne Hospital in Australia, write in an accompanying editorial.
One author from the Musat study disclosed ties to Medtronic.