title: 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.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01058980.
authors: For the author affiliations, please see the Appendix.
authors: Stephan
authors: S
authors: Willems
authors: For the author affiliations, please see the Appendix.
authors: Paul
authors: P
authors: Khairy
authors: For the author affiliations, please see the Appendix.
authors: Jason G
authors: JG
authors: Andrade
authors: For the author affiliations, please see the Appendix.
authors: Boris A
authors: BA
authors: Hoffmann
authors: For the author affiliations, please see the Appendix.
authors: Sylvie
authors: S
authors: Levesque
authors: For the author affiliations, please see the Appendix.
authors: Atul
authors: A
authors: Verma
authors: For the author affiliations, please see the Appendix.
authors: Rukshen
authors: R
authors: Weerasooriya
authors: For the author affiliations, please see the Appendix.
authors: Paul
authors: P
authors: Novak
authors: For the author affiliations, please see the Appendix.
authors: Thomas
authors: T
authors: Arentz
authors: For the author affiliations, please see the Appendix.
authors: Isabel
authors: I
authors: Deisenhofer
authors: For the author affiliations, please see the Appendix.
authors: Thomas
authors: T
authors: Rostock
authors: For the author affiliations, please see the Appendix.
authors: Daniel
authors: D
authors: Steven
authors: For the author affiliations, please see the Appendix.
authors: Lena
authors: L
authors: Rivard
authors: For the author affiliations, please see the Appendix.
authors: Peter G
authors: PG
authors: Guerra
authors: For the author affiliations, please see the Appendix.
authors: Katia
authors: K
authors: Dyrda
authors: For the author affiliations, please see the Appendix.
authors: Blandine
authors: B
authors: Mondesert
authors: For the author affiliations, please see the Appendix.
authors: Marc
authors: M
authors: Dubuc
authors: For the author affiliations, please see the Appendix.
authors: Bernard
authors: B
authors: Thibault
authors: For the author affiliations, please see the Appendix.
authors: Mario
authors: M
authors: Talajic
authors: For the author affiliations, please see the Appendix.
authors: Denis
authors: D
authors: Roy
authors: For the author affiliations, please see the Appendix.
authors: Stanley
authors: S
authors: Nattel
authors: For the author affiliations, please see the Appendix. lmacle@mac.com.
authors: Laurent
authors: L
authors: Macle
mesh_terms: D000241:Adenosine; D000889:Anti-Arrhythmia Agents; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D011667:Pulmonary Veins / Q000601:surgery; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D000241:Adenosine
keywords: atrial fibrillation; catheter ablation; electrophysiology; pulmonary vein; tachycardia