2018 Volume 59 Issue 2 Pages 321-327
Early recurrence (ER) of atrial fibrillation (AF) is common after ablation of longstanding persistent AF. However, optimal timing for repeat ablation has yet to be established.
Two-hundred-four patients (mean age 62 ± 9 years) with longstanding persistent AF underwent catheter ablation including pulmonary vein (PV) isolation and substrate modification. ER defined as AF recurrence within 60 days, occurred in 115 patients (56.4%) 9 ± 1 days after the procedure. Analysis showed optimal blanking period to be 15 days. At 426 ± 224 days of follow-up, 30 of 50 (60.0%) patients with ER during the first 15 days (ER ≤ 15) and 13 of 65 (20.0%) patients with ER from the 16th to the 60th day (ER16-60) were free from protocol-defined treatment failure (PDTF) (P < 0.0001). In multivariate analysis, AF duration and LA diameter were independent predictors of ER16-60. Peak first ER was in the first 5 days, with a small maximum in the day 15~20 bin. The mean time to the first ER was longer in patients found to have PV reconnection during the repeat ablation than in those without (13 ± 14 versus 6 ± 7 days, P = 0.002).
When adopting a blanking period of 15 days, fewer patients with an ER ≤ 15 had PDTF than those with an ER16-60. AF duration and LA diameter were predictive of an ER16-60.
