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Not such a blanking period after all: early recurrence predicts late recurrence after AF ablation
Session:
Comunicações Orais (Sessão 13) - Arritmias 3 - Fibrilhação auricular
Speaker:
Mariana Ribeiro Silva
Congress:
CPC 2022
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mariana Ribeiro Silva; Pedro Ribeiro Queirós; Gualter Santos Silva; Rafael Teixeira; Sara Fernandes; João Almeida; Paulo Fonseca; Marco Oliveira; Helena Gonçalves; Alberto Rodrigues; Sílvia o. Diaz; Francisca Saraiva; António s. Barros; João Primo; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>AF recurrence after catheter ablation (CA) within the blanking period is generally classified as benign<span style="background-color:white"><span style="color:black">, but recently has been associated with later recurrence. The prediction of early recurrence (ERAF) and late recurrence (LRAF) AF after CA remains challenging as well as the predictive value of ERAF.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Objectives: </strong>To determine the clinical and procedural predictors of ERAF and LRAF after CA.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Single-centre retrospective study that included all patients (pts) who underwent AF CA between January 2017 and October 2019. Ablation procedures included radiofrequency and second-generation cryoballoon CA. ERAF was defined as any recurrence of AF, atrial flutter or atrial tachycardia >30 seconds within 90 days after CA and LRAF was defined as any recurrence after 90 days of CA. <span style="background-color:white"><span style="color:#1c1d1e">The independent association between clinical and procedural variables and AF recurrence was evaluated with logistic regression analysis for ERAF and cox regression analysis for LRAF.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>We included 395 pts, 64,6% male and with a mean age of 56,8±11,6 years; most of them had paroxysmal AF (76,7%) with a CHADSVASC score ≥2 points in 41,8%; mean pericardial adipose tissue volume was 149,0±73,2 cm3 and 19,4% of the pts had coronary calcium scoring >100. Overall, median follow-up was 33,0 months (IQR 25-42).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">ERAF occurred in 57 pts (14,4%), on average 29,1±25,3 days after CA. After multivariate logistic regression, we identify left atrium (LA) enlargement (defined as LA indexed volume >34 mL/m2 or LA diameter >38mm for female or >40mm for male) [odds ratio (OR) 4,29 95% confidence interval (CI) 1,38-13,33; p=0,012], persistent AF (OR 2,33, 95% CI 1,01-5,33; p=0,046) and pericardial adipose tissue volume (OR 1,01, 95% CI 1,001-1,01; p=0,020) as independent predictors associated with ERAF.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">LRAF was observed in 129 pts (32,7%), on average, 15,1±10,9 months after CA. Cox regression analysis identified ERAF as the only independent predictor of late recurrence of AF (OR 3,64, 95% CI 2,32-5,71; p<0,001).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Regarding patients with ERAF, most of them also had LRAF (84,2%). In pts with LRAF, it is important to emphasize that 37,2% of them also had ERAF whereas in patients without LRAF only 3,4% had ERAF (p<0,001) (<strong>Figure 1</strong>).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong>In our cohort, LRAF was significantly higher in pts with recurrence within the blanking period, which was the only independent predictor of AF late recurrence. These results support the urgent need for more studies to redefine the blanking period.</span></span></p>
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