Redefining the Blanking Period After Catheter Ablation for Paroxysmal Atrial Fibrillation: Insights From the ADVICE (Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) Trial.

Willems, Stephan; Khairy, Paul; Andrade, Jason G; Hoffmann, Boris A; Levesque, Sylvie; Verma, Atul; Weerasooriya, Rukshen; Novak, Paul; Arentz, Thomas; Deisenhofer, Isabel; Rostock, Thomas; Steven, Daniel; Rivard, Lena; Guerra, Peter G; Dyrda, Katia; Mondesert, Blandine; Dubuc, Marc; Thibault, Bernard; Talajic, Mario; Roy, Denis; Nattel, Stanley; Macle, Laurent

doi:10.1161/CIRCEP.115.003909

journal article

Titel:: Redefining the Blanking Period After Catheter Ablation for Paroxysmal Atrial Fibrillation: Insights From the ADVICE (Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) Trial.
Dokumenttyp:: Journal Article
Autor(en):: Willems, Stephan; Khairy, Paul; Andrade, Jason G; Hoffmann, Boris A; Levesque, Sylvie; Verma, Atul; Weerasooriya, Rukshen; Novak, Paul; Arentz, Thomas; Deisenhofer, Isabel; Rostock, Thomas; Steven, Daniel; Rivard, Lena; Guerra, Peter G; Dyrda, Katia; Mondesert, Blandine; Dubuc, Marc; Thibault, Bernard; Talajic, Mario; Roy, Denis; Nattel, Stanley; Macle, Laurent
Abstract:: Early recurrences (ERs) of atrial tachyarrhythmia are common after catheter ablation of atrial fibrillation. A 3-month blanking period is recommended by current guidelines. This study sought to investigate the significance of ER during the first 3 months post ablation in predicting late recurrences and determine whether it varies according to timing.A total of 401 patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation were followed for 12 months with transtelephonic monitoring in the ADVICE (Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) trial. Patients with atrial tachyarrhythmia >=30 s within the 3-month blanking period were stratified according to the timing of ER. A total of 179 patients (44.6%) experienced their last episode of ER during the first (n=53), second (n=44), or third (n=82) month of the 3-month blanking period. One-year freedom from symptomatic atrial tachyarrhythmia was 77.2% in patients without ER compared with 62.6%, 36.4%, and 7.8% in patients with ER 1, 2, and 3 months post ablation, respectively (P<0.0001). Receiver operating curve analyses revealed a strong correlation between the timing of ER and late recurrence (area under the curve 0.82, P<0.0001). Corresponding hazard ratios for ER during the first, second, and third months were 1.84, 4.45, and 9.64, respectively.This study validates the use of a blanking period after catheter ablation for paroxysmal atrial fibrillation but calls into question the 90-day cut-off value. In particular, >90% of patients with ER during the third month post ablation experience late recurrence by 1 year. However, pending further study, repeat ablation before 90 days cannot be routinely advocated.URL: http://www.clinicaltrials.gov. Unique identifier: NCT01058980.
Zeitschriftentitel:: Circ Arrhythm Electrophysiol
Jahr:: 2016
Band / Volume:: 9
Heft / Issue:: 8
Sprache:: eng
Volltext / DOI:: doi:10.1161/CIRCEP.115.003909
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/27516462
Print-ISSN:: 1941-3149
TUM Einrichtung:: Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2016