Xia Yu, Liu Jun, Jia Yuhe, Zhang Hao, Yu Miao, Li Xiaofeng, Fang Pihua
State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College.
Department of Cardiology, Chongqing General Hospital.
Int Heart J. 2020 Sep 29;61(5):936-943. doi: 10.1536/ihj.20-234. Epub 2020 Sep 2.
On the basis of radiofrequency ablation of atrial fibrillation (AF), some studies suggested that early recurrences of atrial tachyarrhythmia (ERATs) were associated with late AF recurrence (LAFR), and some also suspected and challenged the current recommended 90 day blanking period. We aim to evaluate the impact of ERAT on long-term success and to determine the optimum blanking period after AF ablation using second-generation cryoballoon (sg-CB). From August 2016 to October 2018, 369 consecutive patients who successfully underwent initial AF ablation using sg-CB at the Fuwai Hospital were finally enrolled. All patients were followed up no less than 12 months. Receiver operating characteristic curve analysis was used to determine the optimum blanking period after AF ablation. There were 62 (16.8%) who experienced ERAT. After a median follow-up of 615 days, 74.5% were free of LAFR after the 90 day blanking period. Incidence of freedom from LAFR during the long-term follow-up was markedly lower in patients with ERAT than in those without ERAT (27.4% versus 84.0%; log-rank P < 0.001). Furthermore, only ERAT (HR 8.579; 95% CI 5.604-13.133; P < 0.001) was significantly associated with an increased risk of LAFR after adjusting for other factors. The optimum cut-off time point for the blanking period was 21.5 days (sensitivity: 71.1%, specificity: 94.1%). In conclusion, ERAT was an independent predictor of LAFR after AF ablation using sg-CB. Based on our findings, blanking period was advised to be shorten to 21.5 days or about 3 weeks instead of 90 days after CB ablation.
基于房颤（AF）的射频消融，一些研究表明房性快速性心律失常的早期复发（ERATs）与房颤晚期复发（LAFR）相关，一些研究还对当前推荐的90天空白期提出了怀疑和挑战。我们旨在评估ERAT对长期成功率的影响，并确定使用第二代冷冻球囊（sg-CB）进行房颤消融后的最佳空白期。2016年8月至2018年10月，连续369例在阜外医院成功使用sg-CB进行初次房颤消融的患者最终入组。所有患者均接受了不少于12个月的随访。采用受试者工作特征曲线分析来确定房颤消融后的最佳空白期。有62例（16.8%）经历了ERAT。在中位随访615天后，90天空白期后74.5%的患者无LAFR。ERAT患者在长期随访中无LAFR的发生率明显低于无ERAT的患者（27.4%对84.0%；对数秩检验P<0.001）。此外，在调整其他因素后，只有ERAT（HR 8.579；95%CI 5.604-13.133；P<0.001）与LAFR风险增加显著相关。空白期的最佳截断时间点为21.5天（敏感性：71.1%，特异性：94.1%）。总之，ERAT是使用sg-CB进行房颤消融后LAFR的独立预测因素。基于我们的研究结果，建议将CB消融后的空白期缩短至21.5天或约3周，而不是90天。
