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Rethinking appropriate blanking period after atrial fibrillation ablation

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Abstract

Background

Early recurrence (ER) within a 90-day blanking period (BP) in catheter ablation (CA) for atrial fibrillation (AF) is a risk factor for late recurrence (LR) after 90 days postoperatively. However, few reports have examined them in the second CA and compared them to the first CA. Moreover, in recent years, there have been reports suggesting that BP should be reduced from 90 to 30 days. Therefore, the association between ER and LR in the first and the second CA was examined, and the validity of a 30-day BP was evaluated.

Methods

A total of 511 consecutive patients undergoing the first CA and 116 of these patients undergoing the second CA for AF at a single institution from November 2016 to December 2020 were analyzed retrospectively.

Results

When ER within a 90-day BP was divided into 0–30 days and 31–90 days according to the timing of the last ER episode, the hazard ratios on LR of them relative to no ER were 2.7 {95% confidence interval (CI) 1.7–4.2} and 9.7 (95% CI 6.6–14.3), respectively, for the first CA and 15.3 (95% CI 4.7–50.1) and 44.1 (95% CI 14.0–139.4), respectively, for the second CA.

Conclusions

ER was strongly associated with LR, especially in patients with the last episode of ER more than 30 days after CA. This was pronounced in cases after the second CA, when PVI appeared to be completed. With the current improvement in PVI durability, BP may be acceptable for 30 days.

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Data Availability

The data that support the findings of this study are available from the corresponding author, [KK], upon reasonable request.

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Authors and Affiliations

  1. Division of Cardiology, Japanese Red Cross Otsu Hospital, 1-1-35, Nagara, Otsu, Shiga, 520-8511, Japan

    Naoaki Onishi, Akihira Suenaga, Akinori Yoshida, Takayasu Kobayashi, Shokan Kyo, Maki Oi, Nobuya Higashitani, Fumiko Nakazeki, Naofumi Oyamada, Toshikazu Jinnai & Kazuaki Kaitani

  2. Kusatsu Heart Center, Kusatsu, 520-0014, Japan

    Shokan Kyo

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  1. Naoaki Onishi
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  2. Akihira Suenaga
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Contributions

NOn wrote the manuscript, and KK critically revised it. AS, AY, TK, SK, MO, NH, FN, NOy, and TJ critically read and commented on the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kazuaki Kaitani.

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Competing interests

The authors declare no competing interests. The study protocol was approved on May 10, 2023, by a suitably constituted Ethics Committee of Japanese Red Cross Otsu Hospital (no. 778), and it conforms to the provisions of the Declaration of Helsinki.

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Onishi, N., Suenaga, A., Yoshida, A. et al. Rethinking appropriate blanking period after atrial fibrillation ablation. J Interv Card Electrophysiol (2024). https://doi.org/10.1007/s10840-024-01754-6

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