Early recurrences after catheter ablation for atrial tachycardia: do we need a blanking period?

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background A blanking period after catheter ablation for atrial fibrillation is widely accepted. The clinical implications of early recurrences (ER) after ablation for atrial tachycardia (AT) in patients with a history of atrial fibrillation have not been analysed so far. Purpose To characterise ER and their relationship with late recurrences (LR) after AT ablation. Methods Acute and long-term outcome was studied in a total of 250 patients undergoing catheter ablation for consecutive AT. ER were defined as any documented atrial arrhythmia >30 s within 3 months after ablation. Results In our study population (66.5±0.7 years, 57.6% male), ER were detected in 80 patients (32.0%), with 74.0% of episodes occurring during the first month post-ablation. Patients with ER had a longer history of any atrial arrhythmia (9.1±0.9 years vs. 6.5±0.4 years; P=0.0283), a larger left atrial diameter (65.7±3.1 mm vs. 49.4±1.4 mm; P=0.0163) and a lower left ventricular ejection fraction (50.8±1.1% vs. 56.6±0.6%; P<0.0001) than those without ER. In patients with ER, AT were more often found to be mitral isthmus-dependent (16.5% vs. 6.2%; P=0.0048) or located at the crista terminalis (3.7% vs. 0.4%; P=0.0343). ER were associated with a 6.0-fold (95% CI 3.27-10.81; P<0.0001) and a 4.3-fold (95% CI 1.72-10.72; P=0.0023) increase in the risk of developing LR after a single or multiple ablation procedures, respectively (Figure). After a mean follow-up of 570±23 days, LR were detected in 78.0% vs. 76.9% vs. 50.0% of patients experiencing the first ER during the first, second or third month (P=0.2266). Among these groups, the first LR occurred after 188.7±20.2 days vs. 259.6±59.1 days vs. 400.8±55.5 days (P=0.0459). Conclusions ER after AT ablation are a predictor of LR and clinical as well as procedural risk factors are associated with the occurrence of ER. The prevalence of LR does not differ among patients with early vs. late ER. These findings underline the prognostic importance of ER and challenge the concept of a blanking period after catheter ablation for AT in patients with a history of atrial fibrillation.