Early recurrence after pulmonary vein isolation is associated with inferior long‐term outcomes: Insights from a retrospective cohort study. Issue 10 (17th September 2020)

• Record Type: Journal Article
• Authors: Kalinsek, Tine Prolic; Kottmaier, Marc; Telishevska, Marta; Berger, Florian; Semmler, Verena; Popa, Miruna; Brkic, Amir; Lengauer, Sarah; Otgonbayar, Ulamnemekh; Koch‐Büttner, Katharina; Bartowiak, Marcin; Kornmayer, Marielouise; Brooks, Stephanie; Risse, Elena; Kathan, Susanne; Hofmann, Monika; Grebmer, Christian; Reents, Tilko; Hessling, Gabriele; Deisenhofer, Isabel; Bourier, Felix
• Is Part Of: Pacing and clinical electrophysiology. Volume 43:Issue 10(2020)
• Page Start: 1156
• Page End: 1164
• Publication Date: 2020-09-17
• Subjects: atrial fibrillation -- blanking period -- catheter ablation -- early recurrence; Cardiac pacing -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1111/pace.14060
• Languages: English
• ISSNs: 0147-8389

Abstract

Abstract: Aims: The aim of this retrospective cohort study was to assess the influence of early recurrence (ER) after pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) on long‐term outcomes and to identify clinical variables associated with ER. Methods: We retrospectively collected clinical and procedural data from 1285 patients with paroxysmal AF who underwent PVI from 2011 to 2016. Kaplan‐Meier, receiver operating characteristic (ROC) curve, logistic and Cox regression analyses were performed to analyze the influence of ER on long‐term outcomes. Results: ER was observed in 13% of patients. Kaplan‐Meier analyses showed significantly different outcomes in 1285 patients with and without ER (49% vs 74%, log rank P < .01) and in 286 patients in the subgroup that underwent reablation (44% vs 79%, log rank P < .01). The hazard ratio (HR) of ER was 1.7 within 48 hours (5% of patients), 2.7 within 1 month (5%), 3.0 within 2 months (2%), and 6.4 within 3 months (1%) for late recurrence (LR), P < .01. ROC analysis (area under the curve [AUC] = 0.79) resulted in 70.3% sensitivity and 74.2% specificity for a 14‐day blanking period, and 53.1% sensitivity and 85.5% specificity for a 30‐day blanking period. Female patients (odds ratio [OR] 1.69, P < .01) and those with diabetes (OR 1.95, P = .01) were at higher risk for ER. Conclusions: ER is observed in a substantial number of patients with paroxysmal AF after PVI and has a continuous direct effect on LR according to the timing of ER. Randomized trials are required to assess the safety and effects of reablations in a shortened blanking period on long‐term outcomes.