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Publications

Journal Article Ahead of print 1 citation

PubMed: 42411587 DOI: 10.1093/europace/euag173

Early recurrence of atrial tachyarrhythmia after catheter ablation and its associations with clinical outcomes, atrial fibrillation burden, and blanking period duration: A post hoc analysis of the CABANA trial.

Europace

Authors: Hongyu Liu, Runhui Hu, Wenhui Li, Eva Soler-Espejo, Tommaso Bucci, Yang Liu, Manlin Zhao, Tianshu Gu, Weiguo Fan, Bi Huang, Dhiraj Gupta, Douglas L Packer, Yang Chen, Gregory Y H Lip

Affiliations

  • Department of Cardiovascular medicine, The Second Affiliated Hospital, School of Basic Sciences, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People's Republic of China. Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
  • Department of Cardiovascular medicine, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People's Republic of China.
  • Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK. Department of Computer Science, Faculty of Environment, Science and Economy, University of Exeter, Exeter, UK.
  • Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
  • Department of Hematology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.
  • Internal, Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy.
  • Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK. Department of Cardiovascular medicine, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, People's Republic of China. Jiangxi Provincial Key laboratory of Molecular Medicine, the Second Affiliated Hospital, Nanchang, Jiangxi, People's Republic of China.
  • Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Engineering Research Center of Medical Devices for Cardiovascular Diseases, Ministry of Education, National Clinical Research Center for Cardiovascular Diseases, Beijing, People's Republic of China.
  • Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK. Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China.
  • Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK. Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
  • Department of Cardiology, Intermountain Medical Center, Murray, UT, USA.
  • Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK. Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
  • Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
  • Medical University of Bialystok, 15-089 Bialystok, Poland.

Abstract

AIM

Early recurrence of atrial tachyarrhythmia (ERAT) after catheter ablation for atrial fibrillation (AF) is common, yet its prognostic significance and implications for the duration of the blanking period remain uncertain. We aimed to evaluate the association between ERAT and post-ablation clinical outcomes, late arrhythmia recurrence, and AF burden, and to explore the optimal duration of the blanking period.

METHODS

This post hoc analysis included 811 patients from the CABANA trial who underwent catheter ablation and had trial-specific electrocardiographic monitoring data available. ERAT was defined as any episode of AF, atrial flutter, or atrial tachycardia lasting >30 seconds within the 90-day blanking period. The primary outcome was a composite of all-cause mortality, disabling stroke, serious bleeding, or cardiac arrest. Secondary outcomes included cardiovascular hospitalisation and late atrial tachyarrhythmia recurrence.

RESULTS

During a median 4 years (IQR 2.5-5.2) follow-up, ERAT occurred in 567 patients (69.9%). Patients with ERAT had higher risks of cardiovascular hospitalisation [adjusted hazard ratio (aHR) 1.35, 95% confidence interval (CI) 1.07-1.71] and of the composite outcome of all-cause mortality or cardiovascular hospitalisation (aHR 1.33, 95% CI 1.07-1.66), but no increased risk of the primary composite outcome. ERAT was independently associated with late atrial tachyarrhythmia recurrence (aHR 1.35, 95% CI 1.07-1.71). Prognostic relevance varied by timing, with the strongest association observed for ERAT occurring between 60 and 90 days after ablation (aHR 1.80, 95% CI 1.16-2.79).Receiver operating characteristic analysis identified 58 days as the optimal threshold for predicting late arrhythmia recurrence (AUC 0.727).

CONCLUSIONS

ERAT was associated with higher risks of cardiovascular hospitalisation and late atrial tachyarrhythmia recurrence in a time-dependent manner, supporting a shorter blanking period to better identify patients at risk of adverse rhythm outcomes.

MeSH

Mortality, Arrhythmias, Cardiac, Atrial Fibrillation, Catheter Ablation, Catheters