Mohanty Sanghamitra, Torlapati Prem Geeta, Casella Michela, Della Rocca Domenico G, Schiavone Marco, Doty Brandon, La Fazia Vincenzo Mirco, Pahi Shubham, Pierucci Nicola, Valeri Yari, Gianni Carola, Al-Ahmad Amin, Burkhardt John D, Gallinghouse J G, Di Biase Luigi, Chierchia Gian-Battista, Nair Devi G, Dello Russo Antonio, Tondo Claudio, Natale Andrea
Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
Department of Electrophysiology, Ospedali Riuniti Hospital, Ancona, Italy.
Heart Rhythm. 2025 Apr;22(4):891-897. doi: 10.1016/j.hrthm.2024.08.011. Epub 2024 Aug 6.
Recurrence during the 3-month blanking period after radiofrequency ablation of atrial fibrillation (AF) is typically not considered as a predictor for late recurrence.
We investigated the significance of early recurrence as a risk factor for late recurrence in patients with AF receiving pulsed-field ablation (PFA).
Consecutive patients undergoing PFA were prospectively followed up for 1 year. All patients received isolation of pulmonary veins. Additional ablation procedures were performed per operator's discretion. After the procedure, all remained on their previously ineffective antiarrhythmic drugs (AADs) during the 2-month blanking period after which the AADs were discontinued. Early recurrence was defined as atrial arrhythmia of >30-second duration during the 3-month blanking period, and any recurrence beyond 3 months was considered as late recurrence.
A total of 337 patients undergoing PFA for AF were included. Early recurrence was recorded in 53 patients (15.7%): 10 in the first month, 12 in the second month, and 31 in the third month. Of the 10 patients having recurrence during the first month, 7 (70%) remained in sinus rhythm after cardioversion whereas 3 (30%) underwent a redo procedure because of late recurrence. At 1 year, all patients with recurrence in the second and third months experienced late recurrence; among these patients, 10 (83.3%) of 12 and 27 (87%) of 31 underwent a redo procedure and the remaining 6 patients were in sinus rhythm on AADs.
In this consecutive series of patients with AF, early recurrence in the second or third month after the PFA procedure was associated with a high risk of late recurrence. Thus, blanking period could be redefined as 1 month after PFA.
房颤射频消融术后3个月空白期内的复发通常不被视为晚期复发的预测指标。
我们研究了早期复发作为接受脉冲场消融（PFA）的房颤患者晚期复发危险因素的意义。
对连续接受PFA的患者进行为期1年的前瞻性随访。所有患者均接受肺静脉隔离。根据术者判断进行额外的消融操作。术后，所有患者在2个月的空白期内继续使用之前无效的抗心律失常药物（AADs），之后停用AADs。早期复发定义为在3个月空白期内心房心律失常持续时间>30秒，3个月后出现的任何复发均视为晚期复发。
共纳入337例接受房颤PFA治疗的患者。53例患者（15.7%）出现早期复发：第1个月10例，第2个月12例，第3个月31例。第1个月复发的10例患者中，7例（70%）复律后维持窦性心律，3例（30%）因晚期复发接受再次手术。1年时，第2个月和第3个月复发的所有患者均出现晚期复发；其中，12例中的10例（83.3%）和31例中的27例（87%）接受了再次手术，其余6例患者在使用AADs的情况下维持窦性心律。
在这一系列连续的房颤患者中，PFA术后第2个月或第3个月的早期复发与晚期复发的高风险相关。因此，空白期可重新定义为PFA术后1个月。
