Evidence-based insights on ideal blanking period duration following atrial fibrillation catheter ablation. Issue 12 (2nd August 2022)

• Record Type: Journal Article
• Authors: Saglietto, Andrea; Ballatore, Andrea; Xhakupi, Henri; Rubat Baleuri, Federico; Magnano, Massimo; Gaita, Fiorenzo; De Ferrari, Gaetano Maria; Anselmino, Matteo
• Is Part Of: Europace. Volume 24:Issue 12(2022)
• Page Start: 1899
• Page End: 1908
• Publication Date: 2022-08-02
• Subjects: Atrial fibrillation -- Catheter ablation -- Blanking period -- Early recurrence; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euac098
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: Despite the general adoption of a 3-month blanking period (BP), increasing scientific evidence suggests an association between early recurrences of atrial tachyarrhythmias (ERAT) and failure of atrial fibrillation catheter ablation (AFCA). The aim of the present study was to perform a diagnostic meta-analysis to derive the ideal BP cut-off following AFCA. Methods and results: PubMed/MEDLINE databases were screened for articles reporting late recurrences of atrial tachyarrhythmias (LRAT) in AFCA patients experiencing an ERAT (with at least one time cut-off). Seventeen studies were finally included in the analysis, encompassing 5837 AF patients experiencing ERAT after AFCA. A random-effect meta-analysis of diagnostic test accuracy studies with multiple cut-offs was performed. The day at which the ERAT occurred was considered the diagnostic 'test', whereas the different time cut-offs reported in the singular studies were treated as cut-offs of interest in the meta-analysis. Overall, a 27.7 day (95% confidence interval: 10.4–45.1 days) cut-off was identified as the optimal BP duration [area under the summary receiver operating characteristic (AUC-SROC) curve: 0.66, 95% CI: 0.56–0.75]. Specificity (95% CI: 63–85%) and positive predictive value were 76%. At subgroup analysis, the optimal BP cut-off was 39.0 days (95% CI: 26.8–51.2 days, AUC-SROC: 0.63) following radiofrequency AFCA and 30.1 days (95% CI: 0–63.4 days, AUC-SROC: 0.76) after cryoballoon ablation. Conclusion: The present meta-analysis indicates that a 4-week BP represents the optimal cut-off following AFCA. Altogether, these meta-analytic insights support the need of a revision of the actual 3-month BP duration. Graphical Abstract: Graphical Abstract Summary of the main findings of the systematic review and diagnostic meta-analysis.