Blanking Period Post-Pulmonary Vein Isolation

Study Questions:

What is the most appropriate duration of the blanking period after pulmonary vein antral isolation (PVAI)?

Methods:

This was a retrospective analysis of 636 patients who underwent PVAI for atrial fibrillation (AF; paroxysmal in 59%). A 14-day Holter monitor was performed at 4-6 weeks post-PVAI and a 48-hour Holter monitor was performed at 3, 6, 9, and 12 months of follow-up. Recurrent AF in the first 90 days post-PVAI was defined as early recurrence (ERAF), and recurrences at 3-12 months were defined as late recurrences (LRAF).

Results:

Among the patients with ERAF in the first, second, and third months post-PVAI, LRAF occurred in 51%, 76%, and 92%, respectively. Compared to patients without ERAF, the rate of LRAF was 4.2-fold higher in patients with ERAF in the first month post-PVAI and 19.4-fold higher when the ERAF occurred in the third post-PVAI month. Receiver operating characteristic analysis demonstrated that the optimal duration of the blanking period is 23 days.

Conclusions:

There is a high likelihood of LRAF in patients who have ERAF after the first month post-PVAI. The most appropriate duration for the blanking period is 23 days.

Perspective:

This study confirms the results of prior studies indicating that a post-PVAI blanking period of approximately 3-4 weeks is more appropriate than the traditional 3 months. Transient factors such as post-ablation inflammation or incomplete lesion maturation are very unlikely to account for recurrences of AF that occur in the second and third months post-PVAI.


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