Early recurrence after pulmonary vein isolation is associated with inferior long‐term outcomes: Insights from a retrospective cohort study

• Published in: Pacing and clinical electrophysiology Vol. 43; no. 10; pp. 1156 - 1164
• Main Authors: Kalinsek, Tine Prolic, Kottmaier, Marc, Telishevska, Marta, Berger, Florian, Semmler, Verena, Popa, Miruna, Brkic, Amir, Lengauer, Sarah, Otgonbayar, Ulamnemekh, Koch‐Büttner, Katharina, Bartowiak, Marcin, Kornmayer, Marielouise, Brooks, Stephanie, Risse, Elena, Kathan, Susanne, Hofmann, Monika, Grebmer, Christian, Reents, Tilko, Hessling, Gabriele, Deisenhofer, Isabel, Bourier, Felix
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.10.2020
• Subjects: atrial fibrillation; blanking period; Cardiac arrhythmia; catheter ablation; Clinical trials; Cohort analysis; Diabetes mellitus; early recurrence; Fibrillation; blanking period; atrial fibrillation; catheter ablation; early recurrence
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.14060

Aims The aim of this retrospective cohort study was to assess the influence of early recurrence (ER) after pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) on long‐term outcomes and to identify clinical variables associated with ER. Methods We retrospectively collected clinical and procedural data from 1285 patients with paroxysmal AF who underwent PVI from 2011 to 2016. Kaplan‐Meier, receiver operating characteristic (ROC) curve, logistic and Cox regression analyses were performed to analyze the influence of ER on long‐term outcomes. Results ER was observed in 13% of patients. Kaplan‐Meier analyses showed significantly different outcomes in 1285 patients with and without ER (49% vs 74%, log rank P < .01) and in 286 patients in the subgroup that underwent reablation (44% vs 79%, log rank P < .01). The hazard ratio (HR) of ER was 1.7 within 48 hours (5% of patients), 2.7 within 1 month (5%), 3.0 within 2 months (2%), and 6.4 within 3 months (1%) for late recurrence (LR), P < .01. ROC analysis (area under the curve [AUC] = 0.79) resulted in 70.3% sensitivity and 74.2% specificity for a 14‐day blanking period, and 53.1% sensitivity and 85.5% specificity for a 30‐day blanking period. Female patients (odds ratio [OR] 1.69, P < .01) and those with diabetes (OR 1.95, P = .01) were at higher risk for ER. Conclusions ER is observed in a substantial number of patients with paroxysmal AF after PVI and has a continuous direct effect on LR according to the timing of ER. Randomized trials are required to assess the safety and effects of reablations in a shortened blanking period on long‐term outcomes.