• Giacomo Mugnai, Carlo de Asmundis, Burak Hünük, Erwin Ströker, Vedran Velagic, Darragh Moran, Diego Ruggiero, Ebru Hacioglu, Jan Poelaert, Christian Verborgh, Vincent Umbrain, Stefan Beckers, Hugo Enrique Coutino-Moreno, Ken Takarada, Pedro Brugada, and Gian-Battista Chierchia.
• Heart Rhythm Management Centre. Electronic address: mugnai.giacomo@gmail.com.
• Heart Rhythm. 2016 Apr 1; 13 (4): 845-51.

BackgroundAlthough consensus documents on catheter and surgical ablation of atrial fibrillation (AF) suggest a uniform "blanking period" of 3 months, recent evidence suggested that early recurrences of atrial tachyarrhythmias (ERATs) are strongly associated with late recurrences (LRs), especially if ERATs occurred in the last part of the "blanking period".ObjectiveThe present study sought to assess the role of ERATs in predicting LRs in a large cohort of patients with paroxysmal AF who have undergone second-generation cryoballoon ablation.MethodsConsecutive patients with drug-resistant paroxysmal AF who underwent pulmonary vein isolation using CB-A technology as the index procedure were retrospectively included in our analysis. The exclusion criteria were any contraindications for the procedure, including the presence of an intracavitary thrombus, uncontrolled heart failure, contraindications to general anesthesia, and persistent AF.ResultsA total of 331 consecutive patients (104 women [31%]; mean age 56.7 ± 13.3 years) were enrolled. Atrial tachyarrhythmias/AF recurrences were detected in 57 patients (17.2%). The highest prevalence of ERATs was observed in the first 2 weeks (55%) after pulmonary vein isolation. Of note, all the ERATs occurring 1.5 months after AF ablation relapsed after 3 months and were confirmed as definitive recurrences. Late recurrence of AF and atrial tachycardia occurred in 20 of 29 patients with ERATs (69.0%) and 28 of 302 patients without ERATs (9.3%) (P < .0001). A multivariate Cox regression analysis showed that the early recurrence within the blanking period was significantly and independently associated with an increased risk of developing a late recurrence (hazard ratio 6.79; 95% confidence interval 3.52-10.14; P < .0001).ConclusionOur findings reveal that ERATs are strongly associated with an LR after paroxysmal AF ablation using CB-A technology (hazard ratio 6.79; 95% confidence interval 3.52-10.14; P < .0001). Of note, when ERATs occurred later than 1.5 months, patients systematically experienced an LR.Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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