Redefining the Blanking Period After Catheter Ablation for Paroxysmal Atrial Fibrillation: Insights From the ADVICE (Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) Trial
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Redefining the Blanking Period After Catheter Ablation for Paroxysmal Atrial Fibrillation: Insights From the ADVICE (Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) Trial. / Willems, Stephan; Khairy, Paul; Andrade, Jason G; Hoffmann, Boris A; Levesque, Sylvie; Verma, Atul; Weerasooriya, Rukshen; Novak, Paul; Arentz, Thomas; Deisenhofer, Isabel; Rostock, Thomas; Steven, Daniel; Rivard, Lena; Guerra, Peter G; Dyrda, Katia; Mondesert, Blandine; Dubuc, Marc; Thibault, Bernard; Talajic, Mario; Roy, Denis; Nattel, Stanley; Macle, Laurent; ADVICE trial investigators.
in: CIRC-ARRHYTHMIA ELEC, Jahrgang 9, Nr. 8, 08.2016.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Redefining the Blanking Period After Catheter Ablation for Paroxysmal Atrial Fibrillation: Insights From the ADVICE (Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) Trial
AU - Willems, Stephan
AU - Khairy, Paul
AU - Andrade, Jason G
AU - Hoffmann, Boris A
AU - Levesque, Sylvie
AU - Verma, Atul
AU - Weerasooriya, Rukshen
AU - Novak, Paul
AU - Arentz, Thomas
AU - Deisenhofer, Isabel
AU - Rostock, Thomas
AU - Steven, Daniel
AU - Rivard, Lena
AU - Guerra, Peter G
AU - Dyrda, Katia
AU - Mondesert, Blandine
AU - Dubuc, Marc
AU - Thibault, Bernard
AU - Talajic, Mario
AU - Roy, Denis
AU - Nattel, Stanley
AU - Macle, Laurent
AU - ADVICE trial investigators
N1 - © 2016 American Heart Association, Inc.
PY - 2016/8
Y1 - 2016/8
N2 - BACKGROUND: Early recurrences (ERs) of atrial tachyarrhythmia are common after catheter ablation of atrial fibrillation. A 3-month blanking period is recommended by current guidelines. This study sought to investigate the significance of ER during the first 3 months post ablation in predicting late recurrences and determine whether it varies according to timing.METHODS AND RESULTS: A total of 401 patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation were followed for 12 months with transtelephonic monitoring in the ADVICE (Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) trial. Patients with atrial tachyarrhythmia ≥30 s within the 3-month blanking period were stratified according to the timing of ER. A total of 179 patients (44.6%) experienced their last episode of ER during the first (n=53), second (n=44), or third (n=82) month of the 3-month blanking period. One-year freedom from symptomatic atrial tachyarrhythmia was 77.2% in patients without ER compared with 62.6%, 36.4%, and 7.8% in patients with ER 1, 2, and 3 months post ablation, respectively (P<0.0001). Receiver operating curve analyses revealed a strong correlation between the timing of ER and late recurrence (area under the curve 0.82, P<0.0001). Corresponding hazard ratios for ER during the first, second, and third months were 1.84, 4.45, and 9.64, respectively.CONCLUSIONS: This study validates the use of a blanking period after catheter ablation for paroxysmal atrial fibrillation but calls into question the 90-day cut-off value. In particular, >90% of patients with ER during the third month post ablation experience late recurrence by 1 year. However, pending further study, repeat ablation before 90 days cannot be routinely advocated.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01058980.
AB - BACKGROUND: Early recurrences (ERs) of atrial tachyarrhythmia are common after catheter ablation of atrial fibrillation. A 3-month blanking period is recommended by current guidelines. This study sought to investigate the significance of ER during the first 3 months post ablation in predicting late recurrences and determine whether it varies according to timing.METHODS AND RESULTS: A total of 401 patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation were followed for 12 months with transtelephonic monitoring in the ADVICE (Adenosine Following Pulmonary Vein Isolation to Target Dormant Conduction Elimination) trial. Patients with atrial tachyarrhythmia ≥30 s within the 3-month blanking period were stratified according to the timing of ER. A total of 179 patients (44.6%) experienced their last episode of ER during the first (n=53), second (n=44), or third (n=82) month of the 3-month blanking period. One-year freedom from symptomatic atrial tachyarrhythmia was 77.2% in patients without ER compared with 62.6%, 36.4%, and 7.8% in patients with ER 1, 2, and 3 months post ablation, respectively (P<0.0001). Receiver operating curve analyses revealed a strong correlation between the timing of ER and late recurrence (area under the curve 0.82, P<0.0001). Corresponding hazard ratios for ER during the first, second, and third months were 1.84, 4.45, and 9.64, respectively.CONCLUSIONS: This study validates the use of a blanking period after catheter ablation for paroxysmal atrial fibrillation but calls into question the 90-day cut-off value. In particular, >90% of patients with ER during the third month post ablation experience late recurrence by 1 year. However, pending further study, repeat ablation before 90 days cannot be routinely advocated.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01058980.
KW - Adenosine
KW - Anti-Arrhythmia Agents
KW - Atrial Fibrillation/physiopathology
KW - Catheter Ablation/methods
KW - Electrocardiography
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Monitoring, Ambulatory
KW - Pulmonary Veins/surgery
KW - Recurrence
KW - Treatment Outcome
U2 - 10.1161/CIRCEP.115.003909
DO - 10.1161/CIRCEP.115.003909
M3 - SCORING: Journal article
C2 - 27516462
VL - 9
JO - CIRC-ARRHYTHMIA ELEC
JF - CIRC-ARRHYTHMIA ELEC
SN - 1941-3149
IS - 8
ER -
