Saglietto Andrea, Ballatore Andrea, Xhakupi Henri, Rubat Baleuri Federico, Magnano Massimo, Gaita Fiorenzo, De Ferrari Gaetano Maria, Anselmino Matteo
Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, Torino, Italy.
Cardiology Unit, J Medical, Turin, Italy.
Europace. 2022 Dec 9;24(12):1899-1908. doi: 10.1093/europace/euac098.
Despite the general adoption of a 3-month blanking period (BP), increasing scientific evidence suggests an association between early recurrences of atrial tachyarrhythmias (ERAT) and failure of atrial fibrillation catheter ablation (AFCA). The aim of the present study was to perform a diagnostic meta-analysis to derive the ideal BP cut-off following AFCA.
PubMed/MEDLINE databases were screened for articles reporting late recurrences of atrial tachyarrhythmias (LRAT) in AFCA patients experiencing an ERAT (with at least one time cut-off). Seventeen studies were finally included in the analysis, encompassing 5837 AF patients experiencing ERAT after AFCA. A random-effect meta-analysis of diagnostic test accuracy studies with multiple cut-offs was performed. The day at which the ERAT occurred was considered the diagnostic 'test', whereas the different time cut-offs reported in the singular studies were treated as cut-offs of interest in the meta-analysis. Overall, a 27.7 day (95% confidence interval: 10.4-45.1 days) cut-off was identified as the optimal BP duration [area under the summary receiver operating characteristic (AUC-SROC) curve: 0.66, 95% CI: 0.56-0.75]. Specificity (95% CI: 63-85%) and positive predictive value were 76%. At subgroup analysis, the optimal BP cut-off was 39.0 days (95% CI: 26.8-51.2 days, AUC-SROC: 0.63) following radiofrequency AFCA and 30.1 days (95% CI: 0-63.4 days, AUC-SROC: 0.76) after cryoballoon ablation.
The present meta-analysis indicates that a 4-week BP represents the optimal cut-off following AFCA. Altogether, these meta-analytic insights support the need of a revision of the actual 3-month BP duration.
尽管普遍采用3个月的空白期（BP），但越来越多的科学证据表明房性快速心律失常的早期复发（ERAT）与房颤导管消融术（AFCA）失败之间存在关联。本研究的目的是进行一项诊断性荟萃分析，以得出AFCA术后理想的BP截止值。
在PubMed/MEDLINE数据库中筛选报告了经历ERAT（至少有一个时间截止点）的AFCA患者房性快速心律失常晚期复发（LRAT）的文章。最终有17项研究纳入分析，涵盖5837例AFCA术后经历ERAT的房颤患者。对具有多个截止值的诊断试验准确性研究进行随机效应荟萃分析。将ERAT发生的日期视为诊断“试验”，而单个研究中报告的不同时间截止值则作为荟萃分析中的感兴趣截止值。总体而言，27.7天（95%置信区间：10.4 - 45.1天）的截止值被确定为最佳BP持续时间[汇总接受者操作特征曲线下面积（AUC - SROC）：0.66，95%置信区间：0.56 - 0.75]。特异性（95%置信区间：63 - 85%）和阳性预测值为76%。在亚组分析中，射频AFCA术后的最佳BP截止值为39.0天（95%置信区间：26.8 - 51.2天，AUC - SROC：0.63），冷冻球囊消融术后为30.1天（95%置信区间：0 - 63.4天，AUC - SROC：0.76）。
本荟萃分析表明，4周的BP是AFCA术后的最佳截止值。总之，这些荟萃分析结果支持需要修订目前3个月的BP持续时间。
