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Clinical Trial
. 2023 Jun 2;25(6):euad173.
doi: 10.1093/europace/euad173.

Identifying the prognostic significance of early arrhythmia recurrence during the blanking period and the optimal blanking period duration: insights from the DECAAF II study

Charbel Noujaim  1 , Chanho Lim  1 , Mario Mekhael  1 , Han Feng  1 , Nour Chouman  1 , Hadi Younes  1 , Ala Assaf  1 , Botao Shan  1 , Ghaith Shamaileh  1 , Aneesh Dhore-Patil  1 , Daniel Nelson  1 , Brennan Lanier  1 , Noor Makan  1 , Nassir Marrouche  1 , Eoin Donnellan  1
Affiliations
Clinical Trial

Identifying the prognostic significance of early arrhythmia recurrence during the blanking period and the optimal blanking period duration: insights from the DECAAF II study

Charbel Noujaim et al. Europace. .

Abstract

Objective: Early atrial arrhythmia recurrence following atrial fibrillation (AF) ablation is common. Current guidelines promulgate a 3-month blanking period. We hypothesize that early atrial arrhythmia recurrence during the blanking period may predict longer-term ablation outcomes.

Methods and results: A total of 688 patients with persistent AF undergoing catheter ablation were included in the DECAAF II trial database. The primary endpoint of the study was the first confirmed recurrence of atrial arrhythmia. Recurrence was also monitored during the 90-day blanking period. A total of 287 patients experienced recurrent atrial arrhythmia during the blanking period, while 401 remained in sinus rhythm. Rates of longer-term arrhythmia recurrence were substantially higher among those who developed recurrence during the blanking period compared to those who remained in sinus rhythm throughout the blanking period (68% vs. 32%, P < 0.001). The study cohort was divided into three groups according to the timing of arrhythmia recurrence during the blanking period. Of those who had recurrent arrhythmia during the first month of the blanking period (Group 1), 43.9% experienced longer-term recurrence, compared to 61.6% who recurred during the second month of the blanking period (Group 2), and 93.3% of those who had arrhythmia recurrence during the third month (Group 3, P < 0.001). The risk of recurrent arrhythmia was highest in Group 3 (HR = 10.15), followed by Group 2 (HR = 2.35) and Group 1 (HR = 1.5). Receiver operating characteristic analysis was performed to assess the relationship between the timing of arrhythmia recurrence and the primary outcome (AUC = 0.746, P < 0.001). The optimal blanking period duration was identified as 34 days. Atrial fibrillation burden determined by smartphone electrocardiogram technology over the 18 months follow-up period was significantly higher in Group 3 (29%) compared to Groups 1 (6%) and 2 (7%) and in patients who stayed in sinus rhythm during the blanking period (5%) (P < 0.0001).

Conclusion: Early atrial arrhythmia recurrence during the blanking period, particularly during the third month, is significantly associated with later recurrence. Although a blanking period is warranted, it should be abbreviated.

Keywords: Arrhythmia recurrence; Atrial fibrillation; Atrial fibrillation burden; Blanking period; Catheter ablation.

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Conflict of interest statement

Conflict of interests: Dr Marrouche reported Marrek (founder) and from ECG Check (previous shareholder) outside the submitted work; and a patent issued for MRI fibrosis imaging. No other disclosures were reported.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Primary endpoint of atrial arrhythmia recurrence in the different groups.
Figure 2
Figure 2
Receiver operator characteristics curve to assess correlation of day of recurrence during the blanking period and atrial arrhythmia recurrence.
Figure 3
Figure 3
Primary endpoint of atrial arrhythmia recurrence in patients who had early recurrence between 1–33 days and 34–90 days.
Figure 4
Figure 4
Post-ablation AF burden comparison in the different groups.
See this image and copyright information in PMC

Comment in

References

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