Prevalence, Predictors, and Prognosis of Atrial Fibrillation Early After Pulmonary Vein Isolation: Findings from 3 Months of Continuous Automatic ECG Loop Recordings

• Published in: Journal of cardiovascular electrophysiology Vol. 20; no. 10; pp. 1089 - 1094
• Main Authors: JOSHI, SANDEEP, CHOI, ANDREW D., KAMATH, GANESH S., RAISZADEH, FARBOD, MARRERO, DANIEL, BADHEKA, APURVA, MITTAL, SUNEET, STEINBERG, JONATHAN S.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.10.2009
• Subjects: atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Atrial Fibrillation - surgery; catheter ablation; Catheter Ablation - statistics & numerical data; Electrocardiography, Ambulatory - statistics & numerical data; event monitoring; Female; Heart Conduction System - surgery; Humans; Male; Middle Aged; Prevalence; Prognosis; pulmonary vein isolation; Pulmonary Veins - surgery; radiofrequency; Risk Assessment; Risk Factors; Treatment Outcome
• ISSN: 1045-3873; 1540-8167; 1540-8167
• DOI: 10.1111/j.1540-8167.2009.01506.x

Introduction: Following pulmonary vein isolation (PVI) for atrial fibrillation (AF), early recurrences are frequent, benign and classified as a part of a “blanking period.” This study characterizes early recurrences and determines implications of early AF following PVI. Methods and Results: Seventy‐two consecutive patients (59.8 ± 10.7 years, 69% male) were studied following PVI for paroxysmal or persistent AF. Subjects were fitted with an external loop recorder for automatic, continuous detection of AF recurrence for 3 months. AF prevalence was highest 2 weeks after PVI (54%) and declined to an eventual low of 22%. A significant number (488, 34%) of recurrences were asymptomatic; however, all patients with ≥1 AF event had ≥1 symptomatic event. No clear predictor of early recurrence was identified. Forty‐seven (65%) patients had at least 1 AF episode, predominantly (39 of 47 patients, 83%) within 2 weeks of PVI. Of the 33 patients who did not experience AF within the first 2 weeks, 85% (28/33) were complete responders (P = 0.03) at 12 months. Recurrence at any time within 3 months was not associated with procedural success or failure. Conclusions: Early AF recurrence peaks within the first few weeks after PVI, but continues at a lower level until the completion of monitoring. A blanking period of 3 months is justified to identify patients with AF recurrences that do not portend procedure failure. Freedom from AF in the first 2 weeks following ablation significantly predicts long‐term AF freedom.