Jun Liu1, Hong Yang2, Ying Liu3, Xiaofeng Li1, Hao Zhang1, Yu Xia1, Yuhe Jia1, Pihua Fang4, Min Tang1, Shu Zhang1. 1. Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital, PUMC & CAMS, Beijing, China. 2. Aerospace Central Hospital, Beijing, China. 3. Baoding Second Central Hospital, Hebei, China. 4. Center for Arrhythmia Diagnosis and Treatment, Fu Wai Hospital, PUMC & CAMS, Beijing, China. Electronic address: fangph@vip.sina.com.
Abstract
OBJECTIVE: To investigate the characteristics of early recurrence (ER) of atrial tachyarrhythmia (ATA) defined as atrial fibrillation (AF), atrial tachycardia (AT), or atrial flutter (AFL) during a 90-day blanking period after pulmonary vein isolation by cryoablation (PVI-C) in patients with symptomatic drug refractory AF. Specifically, to determine if ER of ATA during the blanking period can predict late recurrence (LR) during a 12-month follow-up period. METHOD: A total of 51 patients with symptomatic AF (who received PVI-C) were monitored by trans-telephonic wireless electrocardiogram (TWECG) event recording during the landmark 90-day blanking period following an index ablation. Recurrent ATA was defined as any AF, AT, or AFL lasting longer than 30 s (as recorded by 12‑lead ECG, 24-hour Holter monitor, or TWECG). For data analysis, patients were grouped into ER and non-ER cohorts during the 90-day blanking period and then cohorted into LR or non-LR groups during the 12-month follow-up. RESULTS: During the 90-day blanking period, 23 patients had an ER event of ATA while 28 patients had a non-ER experience. Also, during the 12-month follow-up period, 15 patients had a LR event while 36 patients were free from ATA (and placed in the non-LR cohort). Overall, the average success rate of cryoablation for AF was 70.6% at the 12-month follow-up period. Compared to the non-LR group, patients with LR showed a higher average percentage of diabetes mellitic (33.3% vs. 5.56%; P = 0.008) and had a larger mean left atrium diameter (41.2 ± 4.3 mm vs. 36.5 ± 4.2 mm; P = 0.0006). During evaluation of the 90-day blanking period, the LR group had more frequent attacks of ATA than compared to the non-LR group (27.7% vs. 2.4%; P < 0.001). Only two patients (7.1%) without ER in the blanking period (non-ER cohort) had relapsed into a LR of ATA during the one-year period. After multi-logistic regression analysis, ER could individually predict the risk of LR (RR = 58.8; P = 0.001). CONCLUSION: In our study, ER of ATA was a common phenomenon during the 90-day blanking period after PVI-C for AF, and it mostly occurred in the first month following the index ablation across all patients. ER is not equal to the LR of ATA; however, patients with an ER event had a higher risk of a LR during the 12-month follow-up period.
OBJECTIVE: To investigate the characteristics of early recurrence (ER) of atrial tachyarrhythmia (ATA) defined as atrial fibrillation (AF), atrial tachycardia (AT), or atrial flutter (AFL) during a 90-day blanking period after pulmonary vein isolation by cryoablation (PVI-C) in patients with symptomatic drug refractory AF. Specifically, to determine if ER of ATA during the blanking period can predict late recurrence (LR) during a 12-month follow-up period. METHOD: A total of 51 patients with symptomatic AF (who received PVI-C) were monitored by trans-telephonic wireless electrocardiogram (TWECG) event recording during the landmark 90-day blanking period following an index ablation. Recurrent ATA was defined as any AF, AT, or AFL lasting longer than 30 s (as recorded by 12‑lead ECG, 24-hour Holter monitor, or TWECG). For data analysis, patients were grouped into ER and non-ER cohorts during the 90-day blanking period and then cohorted into LR or non-LR groups during the 12-month follow-up. RESULTS: During the 90-day blanking period, 23 patients had an ER event of ATA while 28 patients had a non-ER experience. Also, during the 12-month follow-up period, 15 patients had a LR event while 36 patients were free from ATA (and placed in the non-LR cohort). Overall, the average success rate of cryoablation for AF was 70.6% at the 12-month follow-up period. Compared to the non-LR group, patients with LR showed a higher average percentage of diabetes mellitic (33.3% vs. 5.56%; P = 0.008) and had a larger mean left atrium diameter (41.2 ± 4.3 mm vs. 36.5 ± 4.2 mm; P = 0.0006). During evaluation of the 90-day blanking period, the LR group had more frequent attacks of ATA than compared to the non-LR group (27.7% vs. 2.4%; P < 0.001). Only two patients (7.1%) without ER in the blanking period (non-ER cohort) had relapsed into a LR of ATA during the one-year period. After multi-logistic regression analysis, ER could individually predict the risk of LR (RR = 58.8; P = 0.001). CONCLUSION: In our study, ER of ATA was a common phenomenon during the 90-day blanking period after PVI-C for AF, and it mostly occurred in the first month following the index ablation across all patients. ER is not equal to the LR of ATA; however, patients with an ER event had a higher risk of a LR during the 12-month follow-up period.
Authors: Victoria L Bartlett; Joseph S Ross; Nilay D Shah; Laura Ciaccio; Joseph G Akar; Peter A Noseworthy; Sanket S Dhruva Journal: Cardiovasc Digit Health J Date: 2021-07-03