Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Early recurrences after catheter ablation for atrial tachycardia: Does a blanking period make sense?
A.-K. Kahle1, C. Jungen2, K. Scherschel1, F.-A. Alken1, C. Meyer1
1Klinik für Kardiologie, Evangelisches Krankenhaus Düsseldorf, Düsseldorf; 2Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg;
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) have not been analyzed so far.
Purpose: We aimed to investigate the correlation between ER and late recurrences (LR) and the practicability of a blanking period after AT ablation.
Methods: Acute and long-term outcome was studied in a total of 250 patients who underwent AT ablation after previous atrial interventions. 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% of episodes occurring during the first month post-ablation. Patients with ER had a lower left ventricular ejection fraction (50.8±1.1% vs 56.6±0.6%; P<0.0001), a larger left atrial diameter (65.7±3.1 mm vs 49.4±1.4 mm; P=0.0163), and a longer history of any atrial arrhythmia (9.1±0.9 years vs 6.5±0.4 years; P=0.0283) compared to those without. ER were associated with a 6-fold (95% CI 3.27-10.81; P<0.0001) and a 2.7-fold (95% CI 1.50-4.72; P=0.0007) increase in the risk of developing LR and undergoing a repeat ablation procedure, respectively. ER of AT (OR 5.71; 95% CI 2.93-11.11; P<0.0001) were a stronger predictor of LR of any atrial arrhythmia than ER of atrial fibrillation (OR 3.82; 95% CI 1.64-8.93; P=0.0019). Patients with the first ER during the third month post-ablation remained arrhythmia-free for a longer period of time compared to those experiencing ER during the first or second month (188.7±22.9 days first month vs 259.6±67.3 days second month vs 400.8±78.5 days third month; P=0.0459) but did not present less LR after a mean follow-up of 570±23 days (78.0% vs 76.9% vs 50.0%; P=0.2266).
Conclusions: ER after AT ablation are strongly associated with LR. The timing of ER is related to the time to the first LR, but not to the prevalence of LR. This observation underlines the prognostic importance of ER and challenges the general concept of a blanking period after catheter ablation for AT.




Figure: Early recurrences are associated with late recurrences after catheter ablation for atrial tachycardia.
Early recurrences (ER) during the first 3 months after atrial tachycardia (AT) ablation predict late recurrences (LR) and mainly occur during the first month post-ablation. The timing of ER is related to the time to the first LR. ER of AT (ERAT) are a stronger predictor of LR of any atrial arrhythmia than ER of atrial fibrillation (ERAF).
AT, atrial tachycardia; ER, early recurrences; ERAF, early recurrences of atrial fibrillation; ERAT, early recurrences of atrial tachycardia; LR, late recurrences.

https://dgk.org/kongress_programme/jt2022/aP829.html