Defining Blanking Period Post-Pulmonary Vein Antrum Isolation

Abstract

Objectives: This study sought to determine the exact period after pulmonary vein antrum isolation (PVI) during which early recurrence of atrial tachyarrhythmia (ERAT) does not predict late arrhythmia recurrence (LR), in order to better define the blanking period.

Background: Recurrence of atrial fibrillation after PVI is not uncommon. The first 3 months after PVI have been commonly treated as a blanking period, during which ERAT is not thought to predict LR after PVI; however, recent studies have shown that ERAT does predict LR.

Methods: Baseline and follow-up data for 636 patients (mean age: 61.4 ± 10.6 years; 67.1% male; 59% paroxysmal atrial fibrillation; 31.4% ERAT) who underwent PVI between 2010 and 2014 were included. Recurrences were monitored by electrocardiography and Holter monitoring at 1-, 3-, 6-, 9-, and 12-month intervals post-procedure. Receiver-operating characteristic curve analysis was used to define the blanking period after PVI.

Results: Overall, 51%, 76%, and 92% of patients who had ERAT in the first, second, and third month post-PVI, respectively, also experienced LR (p = 0.001). Using a logistic regression model, those manifesting ERAT during the first, second, and third month post-PVI were 4.22, 9.03, and 19.43 (p = 0.001) times more likely to experience LR, respectively, compared to those without ERAT. Furthermore, receiver-operating characteristic analysis revealed that 23 days post-PVI is the optimal cutoff date for the blanking period, with area under the curve of 0.7, sensitivity of 69.2%, and specificity of 61.2%.

Conclusions: The likelihood of experiencing LR progressively rises with ERAT after the first month post-PVI. Blanking period after PVI should be limited to the first 23 days clinically and in future studies.

Keywords: atrial fibrillation; blanking period; early recurrence; early recurrence of atrial tachyarrhythmia; late recurrence; pulmonary vein isolation.