确定空白期早期心律失常复发的预后意义和最佳空白期持续时间：来自 DECAAF II 研究的见解。

Identifying the prognostic significance of early arrhythmia recurrence during the blanking period and the optimal blanking period duration: insights from the DECAAF II study.

机构信息

Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70130, USA.

出版信息

Europace. 2023 Jun 2;25(6). doi: 10.1093/europace/euad173.

OBJECTIVE

Early atrial arrhythmia recurrence following atrial fibrillation (AF) ablation is common. Current guidelines promulgate a 3-month blanking period. We hypothesize that early atrial arrhythmia recurrence during the blanking period may predict longer-term ablation outcomes.

METHODS AND RESULTS

A total of 688 patients with persistent AF undergoing catheter ablation were included in the DECAAF II trial database. The primary endpoint of the study was the first confirmed recurrence of atrial arrhythmia. Recurrence was also monitored during the 90-day blanking period. A total of 287 patients experienced recurrent atrial arrhythmia during the blanking period, while 401 remained in sinus rhythm. Rates of longer-term arrhythmia recurrence were substantially higher among those who developed recurrence during the blanking period compared to those who remained in sinus rhythm throughout the blanking period (68% vs. 32%, P < 0.001). The study cohort was divided into three groups according to the timing of arrhythmia recurrence during the blanking period. Of those who had recurrent arrhythmia during the first month of the blanking period (Group 1), 43.9% experienced longer-term recurrence, compared to 61.6% who recurred during the second month of the blanking period (Group 2), and 93.3% of those who had arrhythmia recurrence during the third month (Group 3, P < 0.001). The risk of recurrent arrhythmia was highest in Group 3 (HR = 10.15), followed by Group 2 (HR = 2.35) and Group 1 (HR = 1.5). Receiver operating characteristic analysis was performed to assess the relationship between the timing of arrhythmia recurrence and the primary outcome (AUC = 0.746, P < 0.001). The optimal blanking period duration was identified as 34 days. Atrial fibrillation burden determined by smartphone electrocardiogram technology over the 18 months follow-up period was significantly higher in Group 3 (29%) compared to Groups 1 (6%) and 2 (7%) and in patients who stayed in sinus rhythm during the blanking period (5%) (P < 0.0001).

CONCLUSION

Early atrial arrhythmia recurrence during the blanking period, particularly during the third month, is significantly associated with later recurrence. Although a blanking period is warranted, it should be abbreviated.

目的

心房颤动（AF）消融后早期房性心律失常复发较为常见。目前的指南规定了 3 个月的空白期。我们假设空白期内早期房性心律失常的复发可能预测更长期的消融结果。

方法和结果

共纳入 688 例持续性 AF 行导管消融的 DECAAF II 试验数据库患者。该研究的主要终点是首次确诊的房性心律失常复发。在空白期内也监测复发情况。共有 287 例患者在空白期内出现房性心律失常复发，而 401 例患者仍处于窦性心律。与整个空白期内保持窦性心律的患者相比，在空白期内出现复发的患者更易发生长期心律失常复发（68%比 32%，P < 0.001）。根据空白期内心律失常复发的时间，将研究队列分为三组。在空白期的第一个月发生心律失常复发的患者（第 1 组）中，有 43.9%的患者发生长期复发，而在空白期的第二个月发生心律失常复发的患者（第 2 组）中，有 61.6%的患者发生长期复发，而在空白期的第三个月发生心律失常复发的患者（第 3 组）中，有 93.3%的患者发生长期复发（P < 0.001）。第 3 组的心律失常复发风险最高（HR = 10.15），其次是第 2 组（HR = 2.35）和第 1 组（HR = 1.5）。进行了受试者工作特征分析以评估心律失常复发的时间与主要结局之间的关系（AUC = 0.746，P < 0.001）。确定最佳空白期持续时间为 34 天。在 18 个月的随访期间，通过智能手机心电图技术确定的房颤负荷在第 3 组（29%）显著高于第 1 组（6%）和第 2 组（7%），也显著高于在空白期保持窦性心律的患者（5%）（P < 0.0001）。