Early Recurrence of Atrial Tachyarrhythmias Following Radiofrequency Catheter Ablation of Atrial Fibrillation

Jason G. Andrade. M.D.; Paul Khairy, M.D., PH.D.; Atul Verma, M.D.; Peter G. Guerra, M.D.; Marc Dubuc, M.D.; Lena Rivard, M.D.; Marc W. Deyell, M.D., M.SC.; Blandine Mondesert, M.D.; Bernard Thibault, M.D.; Mario Talajic, M.D.; Denis Roy, M.D.; Laurent Macle, M.D.

Disclosures

Pacing Clin Electrophysiol. 2012;35(1):106-116. 

In This Article

Abstract and Introduction

Abstract

The use of blanking periods, the immediate period postablation during which transient tachyarrhythmia episodes are not considered recurrences, has been predicated on the assumption that not all early recurrences of atrial tachyarrhythmias (ERAT) will lead to later recurrences and, as such, does not necessarily represent treatment failure. While ERAT can be expected to occur in approximately 38% of patients within the first 3 months of atrial fibrillation (AF) ablation, only half of these patients will manifest later recurrences. Clinical features related to the patient's history of AF, the index ablation procedure, and particularities of the ERAT can help identify patients at higher risk of later recurrence in whom aggressive attempts to control rhythm, including early cardioversion and reintervention, may be justified.

Introduction

The use of a blanking period, the immediate period postablation during which transient tachyarrhythmia episodes are not considered recurrences, has been employed in up to 25% of studies examining the efficacy of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF).[1] The use of blanking periods has been predicated on the assumption that not all early recurrences of atrial tachyarrhythmias (ERAT) will lead to later recurrences and, as such, does not necessarily represent treatment failure. Recent studies examining the significance of these early arrhythmias have yielded divergent results.[2–28] The purpose of this review is to examine the rationale for the continued use of blanking periods and to determine which patients with ERAT remain at risk of longer term recurrence and may, therefore, benefit from aggressive attempts to control rhythm, including early reintervention.

It is well described that at least 10% of all arrhythmias observed in the early phase following AF ablation are left atrial tachycardia (AT) or atrial flutter (AFL), both of which result from the induction of anatomic and electrical barriers created by LA ablation.[22–23,27,29,30] Therefore, for the sake of this review, the occurrence of any atrial tachyarrhyhmia (AT, AFL, or AF) postindex AF ablation was considered a recurrence, an approach advocated by the recent Heart Rhythm Society/European Heart Rhythm Society/European Cardiac Arrhythmia Society (HRS/EHRA/ECAS) expert consensus recommendation.[31] While the importance of differentiating AT/AFL from AF may be desirable in some, in the majority of cases, the specific arrhythmia subtype appears to have little effect on subsequent patient management and risk of further arrhythmia recurrence.[23,28,29,32,33]

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