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Significance of early recurrence of atrial fibrillation after catheter ablation: a nationwide Danish cohort study

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

Recurrence of atrial tachyarrhythmias after ablation of atrial fibrillation (AF) is common, although consensus guidelines advise against immediate re-ablation of “early recurrences” (occurring ≤ 90 days after ablation). However, recent studies show early recurrence is associated with “late recurrence” (occurring > 90 days) and question the duration of this “blanking period.” We investigated incidence and timing of early recurrence in relation to late recurrence in a large nationwide cohort.

Methods

From Danish nationwide registers, we included all patients aged 18 and older who underwent first-time ablation for AF between January 2005 and April 2017 and followed them for up to 2 years.

Results

Of the total 7339 patients included (72% male; median age 62 years), 2801 (38%) experienced early recurrence. The odds of late recurrence were 2.34 times higher (95% confidence interval, 2.09–2.63; P < 0.001) given early recurrence, compared with those without early recurrence. In particular, both timing and frequency of early recurrences were associated with a significantly higher odds of late recurrence in a graded relationship: odds ratio (OR) 2.08/4.96/6.25 for early recurrences in the first/second/third month respectively (all P < 0.001); and OR 1.64/2.83/5.14 for those experiencing one/two/more than two episodes respectively (all P < 0.001); compared with those without early recurrence.

Conclusion

In patients undergoing first-time ablation for AF, both the frequency and later onset of early recurrence are significantly associated with higher odds of late recurrence. This suggests the arbitrary blanking period should be abandoned in favor of a case-by-case assessment when evaluating candidates for re-ablation.

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Authors and Affiliations

  1. Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Copenhagen, Denmark

    Gethin Hodges, Morten Lock Hansen, Anne-Marie Schjerning, Jim Hansen, Arne Johannessen, Gunnar H. Gislason & Jannik Pallisgaard

  2. Herlev Hospital, Herlev Ringvej 75, 2730, Herlev, Denmark

    Gethin Hodges

  3. The Danish Heart Foundation, Copenhagen, Denmark

    Casper N. Bang & Gunnar H. Gislason

  4. The Heart Centre, Rigshospitalet, Copenhagen, Denmark

    Casper N. Bang

  5. Department of Health Science and Technology, Aalborg University, Aalborg, Denmark

    Christian Torp-Pedersen

  6. Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark

    Christian Torp-Pedersen

  7. The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark

    Gunnar H. Gislason

  8. Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Gunnar H. Gislason

Authors
  1. Gethin Hodges
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  2. Casper N. Bang
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  3. Christian Torp-Pedersen
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  4. Morten Lock Hansen
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  5. Anne-Marie Schjerning
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  6. Jim Hansen
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  7. Arne Johannessen
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  8. Gunnar H. Gislason
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  9. Jannik Pallisgaard
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Corresponding author

Correspondence to Gethin Hodges.

Ethics declarations

In Denmark, retrospective register studies do not require approval from the ethics committees. The Danish Data Protection Agency approved this study (ref. no. 2007-58-0015/GEH-2014-016 I-Suite no. 02734) and data were made available in an anonymized format such that specific individuals could not be identified.

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The authors declare that they have no conflict of interest.

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Hodges, G., Bang, C.N., Torp-Pedersen, C. et al. Significance of early recurrence of atrial fibrillation after catheter ablation: a nationwide Danish cohort study. J Interv Card Electrophysiol 60, 271–278 (2021). https://doi.org/10.1007/s10840-020-00741-x

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  • DOI: https://doi.org/10.1007/s10840-020-00741-x

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