title: Second-generation cryoballoon ablation for paroxysmal atrial fibrillation: Predictive role of atrial arrhythmias occurring in the blanking period on the incidence of late recurrences.
abstract: BACKGROUND
  Although consensus documents on catheter and surgical ablation of atrial fibrillation (AF) suggest a uniform "blanking period" of 3 months, recent evidence suggested that early recurrences of atrial tachyarrhythmias (ERATs) are strongly associated with late recurrences (LRs), especially if ERATs occurred in the last part of the "blanking period".
  
  
  OBJECTIVE
  The present study sought to assess the role of ERATs in predicting LRs in a large cohort of patients with paroxysmal AF who have undergone second-generation cryoballoon ablation.
  
  
  METHODS
  Consecutive patients with drug-resistant paroxysmal AF who underwent pulmonary vein isolation using CB-A technology as the index procedure were retrospectively included in our analysis. The exclusion criteria were any contraindications for the procedure, including the presence of an intracavitary thrombus, uncontrolled heart failure, contraindications to general anesthesia, and persistent AF.
  
  
  RESULTS
  A total of 331 consecutive patients (104 women [31%]; mean age 56.7 ± 13.3 years) were enrolled. Atrial tachyarrhythmias/AF recurrences were detected in 57 patients (17.2%). The highest prevalence of ERATs was observed in the first 2 weeks (55%) after pulmonary vein isolation. Of note, all the ERATs occurring 1.5 months after AF ablation relapsed after 3 months and were confirmed as definitive recurrences. Late recurrence of AF and atrial tachycardia occurred in 20 of 29 patients with ERATs (69.0%) and 28 of 302 patients without ERATs (9.3%) (P < .0001). A multivariate Cox regression analysis showed that the early recurrence within the blanking period was significantly and independently associated with an increased risk of developing a late recurrence (hazard ratio 6.79; 95% confidence interval 3.52-10.14; P < .0001).
  
  
  CONCLUSIONS
  Our findings reveal that ERATs are strongly associated with an LR after paroxysmal AF ablation using CB-A technology (hazard ratio 6.79; 95% confidence interval 3.52-10.14; P < .0001). Of note, when ERATs occurred later than 1.5 months, patients systematically experienced an LR.
authors.affiliation: Heart Rhythm Management Centre. Electronic address: mugnai.giacomo@gmail.com.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Mugnai
authors.affiliation: Heart Rhythm Management Centre.
authors.forename: Carlo
authors.initials: C
authors.lastname: de Asmundis
authors.affiliation: Heart Rhythm Management Centre.
authors.forename: Burak
authors.initials: B
authors.lastname: Hünük
authors.affiliation: Heart Rhythm Management Centre.
authors.forename: Erwin
authors.initials: E
authors.lastname: Ströker
authors.affiliation: Heart Rhythm Management Centre.
authors.forename: Vedran
authors.initials: V
authors.lastname: Velagic
authors.affiliation: Heart Rhythm Management Centre.
authors.forename: Darragh
authors.initials: D
authors.lastname: Moran
authors.affiliation: Heart Rhythm Management Centre.
authors.forename: Diego
authors.initials: D
authors.lastname: Ruggiero
authors.affiliation: Heart Rhythm Management Centre.
authors.forename: Ebru
authors.initials: E
authors.lastname: Hacioglu
authors.affiliation: Department of Anaesthesiology, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Poelaert
authors.affiliation: Department of Anaesthesiology, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Christian
authors.initials: C
authors.lastname: Verborgh
authors.affiliation: Department of Anaesthesiology, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Umbrain
authors.affiliation: Department of Anaesthesiology, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Stefan
authors.initials: S
authors.lastname: Beckers
authors.affiliation: Heart Rhythm Management Centre.
authors.forename: Hugo Enrique
authors.initials: HE
authors.lastname: Coutino-Moreno
authors.affiliation: Heart Rhythm Management Centre.
authors.forename: Ken
authors.initials: K
authors.lastname: Takarada
authors.affiliation: Heart Rhythm Management Centre.
authors.forename: Pedro
authors.initials: P
authors.lastname: Brugada
authors.affiliation: Heart Rhythm Management Centre.
authors.forename: Gian-Battista
authors.initials: GB
authors.lastname: Chierchia
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013614:Tachycardia, Paroxysmal / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Blanking period; Early recurrence; Pulmonary vein isolation; Second-generation cryoballoon