Recurrences in the Blanking Period and 12‐Month Success Rate by Continuous Cardiac Monitoring After Cryoablation of Paroxysmal and Non‐Paroxysmal Atrial Fibrillation
Early and Late Recurrences in AF Cryoablation Introduction Recurrences within the blanking period (early recurrences) are common after atrial fibrillation (AF) ablation by pulmonary vein isolation (PVI), but their clinical significance is still controversial. We aimed at evaluating the significance...
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| Veröffentlicht in: | Journal of cardiovascular electrophysiology 2017-06, Vol.28 (6), p.625-633 |
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| creator | PIERAGNOLI, PAOLO PAOLETTI PERINI, ALESSANDRO RICCIARDI, GIUSEPPE CHECCHI, LUCA GIOMI, ANDREA MURACA, IACOPO MANNUCCI, LETIZIA PADELETTI, LUIGI |
| description | Early and Late Recurrences in AF Cryoablation
Introduction
Recurrences within the blanking period (early recurrences) are common after atrial fibrillation (AF) ablation by pulmonary vein isolation (PVI), but their clinical significance is still controversial. We aimed at evaluating the significance of within‐blanking recurrences at 12‐month follow‐up after cryoballoon (CB) PVI, and to assess the real procedural success rate by continuous monitoring of cardiac rhythm.
Methods and Results
Sixty consecutive AF patients (34 paroxysmal, 56.7%) underwent their first CB‐PVI at one Italian center (May 2013 to April 2015), and subsequent implantation of an implantable loop recorder (ILR). Overall, 12‐month success rate after the blanking period was 55%. The shortest detected event was 7 minutes long. Late recurrences were more frequent in non‐paroxysmal (19/26, 73.1%) than in paroxysmal AF (8/34, 23.5%; P |
| doi_str_mv | 10.1111/jce.13190 |
| format | Article |
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Introduction
Recurrences within the blanking period (early recurrences) are common after atrial fibrillation (AF) ablation by pulmonary vein isolation (PVI), but their clinical significance is still controversial. We aimed at evaluating the significance of within‐blanking recurrences at 12‐month follow‐up after cryoballoon (CB) PVI, and to assess the real procedural success rate by continuous monitoring of cardiac rhythm.
Methods and Results
Sixty consecutive AF patients (34 paroxysmal, 56.7%) underwent their first CB‐PVI at one Italian center (May 2013 to April 2015), and subsequent implantation of an implantable loop recorder (ILR). Overall, 12‐month success rate after the blanking period was 55%. The shortest detected event was 7 minutes long. Late recurrences were more frequent in non‐paroxysmal (19/26, 73.1%) than in paroxysmal AF (8/34, 23.5%; P <0.001). Early recurrences occurred in 17 (28.3%) patients, with 14 also having late recurrences (82.3%), while only 13 out of 43 (30.2%) without within‐blanking recurrences experienced post‐blanking events (P <0.001). Overall, early recurrences showed 51.8% sensitivity (95% CI 31.9–71.3%) and 90.9% specificity (95% CI 75.7–98.1%) for later recurrences, with 82.3% (95% CI 56.6–96.2%) positive and 69.8% (95% CI 53.9–82.8%) negative predictive value. The positive likelihood ratio was 5.7 (95% CI 1.8–17.8). At multivariable analysis, non‐paroxysmal AF (HR: 3.113; 95% CI 1.309–7.403; P = 0.010) and within‐blanking recurrences (HR: 3.453; 95% CI 1.544–7.722; P = 0.003) were independent predictors of post‐blanking AT/AF.
Conclusion
CB‐PVI for paroxysmal AF shows a 12‐month success rate of 76.5% after one single procedure, as assessed by continuous cardiac rhythm monitoring. Within‐blanking recurrences predict the ablation failure in more than 80% of patients.</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.13190</identifier><identifier>PMID: 28211197</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Ablation ; Action Potentials ; Adult ; Aged ; Atrial Fibrillation - diagnosis ; Atrial Fibrillation - physiopathology ; Atrial Fibrillation - surgery ; Blanking ; blanking period ; Cardiac arrhythmia ; Chi-Square Distribution ; cryoballoon ablation ; Cryosurgery - adverse effects ; Disease-Free Survival ; early recurrence ; Electrocardiography, Ambulatory - methods ; Female ; Fibrillation ; Heart diseases ; Heart Rate ; Humans ; implantable loop recorder ; Implantation ; Italy ; Kaplan-Meier Estimate ; late recurrence ; Likelihood ratio ; Male ; Middle Aged ; Multivariate Analysis ; paroxysmal atrial fibrillation ; Predictive Value of Tests ; Proportional Hazards Models ; Pulmonary Veins - physiopathology ; Pulmonary Veins - surgery ; Recurrence ; Reproducibility of Results ; Retrospective Studies ; Risk Factors ; Signal Processing, Computer-Assisted ; Success ; Telemetry ; Time Factors ; Treatment Outcome</subject><ispartof>Journal of cardiovascular electrophysiology, 2017-06, Vol.28 (6), p.625-633</ispartof><rights>2017 Wiley Periodicals, Inc.</rights><rights>Journal compilation © 2017 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4190-db6e1d9960270e50a6186c50c25c9b2464058b48481435d9286861332ff5c2be3</citedby><cites>FETCH-LOGICAL-c4190-db6e1d9960270e50a6186c50c25c9b2464058b48481435d9286861332ff5c2be3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjce.13190$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjce.13190$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,782,786,1419,27931,27932,45581,45582</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28211197$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>PIERAGNOLI, PAOLO</creatorcontrib><creatorcontrib>PAOLETTI PERINI, ALESSANDRO</creatorcontrib><creatorcontrib>RICCIARDI, GIUSEPPE</creatorcontrib><creatorcontrib>CHECCHI, LUCA</creatorcontrib><creatorcontrib>GIOMI, ANDREA</creatorcontrib><creatorcontrib>MURACA, IACOPO</creatorcontrib><creatorcontrib>MANNUCCI, LETIZIA</creatorcontrib><creatorcontrib>PADELETTI, LUIGI</creatorcontrib><title>Recurrences in the Blanking Period and 12‐Month Success Rate by Continuous Cardiac Monitoring After Cryoablation of Paroxysmal and Non‐Paroxysmal Atrial Fibrillation</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>Early and Late Recurrences in AF Cryoablation
Introduction
Recurrences within the blanking period (early recurrences) are common after atrial fibrillation (AF) ablation by pulmonary vein isolation (PVI), but their clinical significance is still controversial. We aimed at evaluating the significance of within‐blanking recurrences at 12‐month follow‐up after cryoballoon (CB) PVI, and to assess the real procedural success rate by continuous monitoring of cardiac rhythm.
Methods and Results
Sixty consecutive AF patients (34 paroxysmal, 56.7%) underwent their first CB‐PVI at one Italian center (May 2013 to April 2015), and subsequent implantation of an implantable loop recorder (ILR). Overall, 12‐month success rate after the blanking period was 55%. The shortest detected event was 7 minutes long. Late recurrences were more frequent in non‐paroxysmal (19/26, 73.1%) than in paroxysmal AF (8/34, 23.5%; P <0.001). Early recurrences occurred in 17 (28.3%) patients, with 14 also having late recurrences (82.3%), while only 13 out of 43 (30.2%) without within‐blanking recurrences experienced post‐blanking events (P <0.001). Overall, early recurrences showed 51.8% sensitivity (95% CI 31.9–71.3%) and 90.9% specificity (95% CI 75.7–98.1%) for later recurrences, with 82.3% (95% CI 56.6–96.2%) positive and 69.8% (95% CI 53.9–82.8%) negative predictive value. The positive likelihood ratio was 5.7 (95% CI 1.8–17.8). At multivariable analysis, non‐paroxysmal AF (HR: 3.113; 95% CI 1.309–7.403; P = 0.010) and within‐blanking recurrences (HR: 3.453; 95% CI 1.544–7.722; P = 0.003) were independent predictors of post‐blanking AT/AF.
Conclusion
CB‐PVI for paroxysmal AF shows a 12‐month success rate of 76.5% after one single procedure, as assessed by continuous cardiac rhythm monitoring. Within‐blanking recurrences predict the ablation failure in more than 80% of patients.</description><subject>Ablation</subject><subject>Action Potentials</subject><subject>Adult</subject><subject>Aged</subject><subject>Atrial Fibrillation - diagnosis</subject><subject>Atrial Fibrillation - physiopathology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Blanking</subject><subject>blanking period</subject><subject>Cardiac arrhythmia</subject><subject>Chi-Square Distribution</subject><subject>cryoballoon ablation</subject><subject>Cryosurgery - adverse effects</subject><subject>Disease-Free Survival</subject><subject>early recurrence</subject><subject>Electrocardiography, Ambulatory - methods</subject><subject>Female</subject><subject>Fibrillation</subject><subject>Heart diseases</subject><subject>Heart Rate</subject><subject>Humans</subject><subject>implantable loop recorder</subject><subject>Implantation</subject><subject>Italy</subject><subject>Kaplan-Meier Estimate</subject><subject>late recurrence</subject><subject>Likelihood ratio</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>paroxysmal atrial fibrillation</subject><subject>Predictive Value of Tests</subject><subject>Proportional Hazards Models</subject><subject>Pulmonary Veins - physiopathology</subject><subject>Pulmonary Veins - surgery</subject><subject>Recurrence</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Signal Processing, Computer-Assisted</subject><subject>Success</subject><subject>Telemetry</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU9u1TAQhy1ERdsHCy6ALLGhi7T-EzvO8hG1FNRCVWBtOY5D_cizi50IsuMIXKPX4iRMm4IQEt6MNfr8aTw_hJ5SckjhHG2sO6Sc1uQB2qOiJIWisnoId1KKgquK76L9nDeEUC6JeIR2mWLwrq720M2ls1NKLliXsQ94vHL45WDCZx8-4QuXfOywCR2m7Of3H-cxjFf4_WQBzvjSjA63M26g68MUp4wbkzpvLAbQjzHdOtb96BJu0hxNO5jRx4Bjjy9Mit_mvDXDnf1tDKD_q7kek4dy4tvkh-XZY7TTmyG7J_d1hT6eHH9oTouzd69eN-uzwpawgaJrpaNdXUvCKuIEMZIqaQWxTNi6ZaUsiVBtqUpFSy66mimpJOWc9b2wrHV8hV4s3usUv0wuj3rrs3UwRXDwRw06sCsCa12h5_-gmzilANNpGKUSZc0IB-pgoWyKOSfX6-vktybNmhJ9m5-G_PRdfsA-uzdO7dZ1f8jfgQFwtABf_eDm_5v0m-Z4Uf4C2D6mcQ</recordid><startdate>201706</startdate><enddate>201706</enddate><creator>PIERAGNOLI, PAOLO</creator><creator>PAOLETTI PERINI, ALESSANDRO</creator><creator>RICCIARDI, GIUSEPPE</creator><creator>CHECCHI, LUCA</creator><creator>GIOMI, ANDREA</creator><creator>MURACA, IACOPO</creator><creator>MANNUCCI, LETIZIA</creator><creator>PADELETTI, LUIGI</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201706</creationdate><title>Recurrences in the Blanking Period and 12‐Month Success Rate by Continuous Cardiac Monitoring After Cryoablation of Paroxysmal and Non‐Paroxysmal Atrial Fibrillation</title><author>PIERAGNOLI, PAOLO ; PAOLETTI PERINI, ALESSANDRO ; RICCIARDI, GIUSEPPE ; CHECCHI, LUCA ; GIOMI, ANDREA ; MURACA, IACOPO ; MANNUCCI, LETIZIA ; PADELETTI, LUIGI</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4190-db6e1d9960270e50a6186c50c25c9b2464058b48481435d9286861332ff5c2be3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Ablation</topic><topic>Action Potentials</topic><topic>Adult</topic><topic>Aged</topic><topic>Atrial Fibrillation - diagnosis</topic><topic>Atrial Fibrillation - physiopathology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Blanking</topic><topic>blanking period</topic><topic>Cardiac arrhythmia</topic><topic>Chi-Square Distribution</topic><topic>cryoballoon ablation</topic><topic>Cryosurgery - adverse effects</topic><topic>Disease-Free Survival</topic><topic>early recurrence</topic><topic>Electrocardiography, Ambulatory - methods</topic><topic>Female</topic><topic>Fibrillation</topic><topic>Heart diseases</topic><topic>Heart Rate</topic><topic>Humans</topic><topic>implantable loop recorder</topic><topic>Implantation</topic><topic>Italy</topic><topic>Kaplan-Meier Estimate</topic><topic>late recurrence</topic><topic>Likelihood ratio</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>paroxysmal atrial fibrillation</topic><topic>Predictive Value of Tests</topic><topic>Proportional Hazards Models</topic><topic>Pulmonary Veins - physiopathology</topic><topic>Pulmonary Veins - surgery</topic><topic>Recurrence</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Signal Processing, Computer-Assisted</topic><topic>Success</topic><topic>Telemetry</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>PIERAGNOLI, PAOLO</creatorcontrib><creatorcontrib>PAOLETTI PERINI, ALESSANDRO</creatorcontrib><creatorcontrib>RICCIARDI, GIUSEPPE</creatorcontrib><creatorcontrib>CHECCHI, LUCA</creatorcontrib><creatorcontrib>GIOMI, ANDREA</creatorcontrib><creatorcontrib>MURACA, IACOPO</creatorcontrib><creatorcontrib>MANNUCCI, LETIZIA</creatorcontrib><creatorcontrib>PADELETTI, LUIGI</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>PIERAGNOLI, PAOLO</au><au>PAOLETTI PERINI, ALESSANDRO</au><au>RICCIARDI, GIUSEPPE</au><au>CHECCHI, LUCA</au><au>GIOMI, ANDREA</au><au>MURACA, IACOPO</au><au>MANNUCCI, LETIZIA</au><au>PADELETTI, LUIGI</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Recurrences in the Blanking Period and 12‐Month Success Rate by Continuous Cardiac Monitoring After Cryoablation of Paroxysmal and Non‐Paroxysmal Atrial Fibrillation</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2017-06</date><risdate>2017</risdate><volume>28</volume><issue>6</issue><spage>625</spage><epage>633</epage><pages>625-633</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><abstract>Early and Late Recurrences in AF Cryoablation
Introduction
Recurrences within the blanking period (early recurrences) are common after atrial fibrillation (AF) ablation by pulmonary vein isolation (PVI), but their clinical significance is still controversial. We aimed at evaluating the significance of within‐blanking recurrences at 12‐month follow‐up after cryoballoon (CB) PVI, and to assess the real procedural success rate by continuous monitoring of cardiac rhythm.
Methods and Results
Sixty consecutive AF patients (34 paroxysmal, 56.7%) underwent their first CB‐PVI at one Italian center (May 2013 to April 2015), and subsequent implantation of an implantable loop recorder (ILR). Overall, 12‐month success rate after the blanking period was 55%. The shortest detected event was 7 minutes long. Late recurrences were more frequent in non‐paroxysmal (19/26, 73.1%) than in paroxysmal AF (8/34, 23.5%; P <0.001). Early recurrences occurred in 17 (28.3%) patients, with 14 also having late recurrences (82.3%), while only 13 out of 43 (30.2%) without within‐blanking recurrences experienced post‐blanking events (P <0.001). Overall, early recurrences showed 51.8% sensitivity (95% CI 31.9–71.3%) and 90.9% specificity (95% CI 75.7–98.1%) for later recurrences, with 82.3% (95% CI 56.6–96.2%) positive and 69.8% (95% CI 53.9–82.8%) negative predictive value. The positive likelihood ratio was 5.7 (95% CI 1.8–17.8). At multivariable analysis, non‐paroxysmal AF (HR: 3.113; 95% CI 1.309–7.403; P = 0.010) and within‐blanking recurrences (HR: 3.453; 95% CI 1.544–7.722; P = 0.003) were independent predictors of post‐blanking AT/AF.
Conclusion
CB‐PVI for paroxysmal AF shows a 12‐month success rate of 76.5% after one single procedure, as assessed by continuous cardiac rhythm monitoring. Within‐blanking recurrences predict the ablation failure in more than 80% of patients.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28211197</pmid><doi>10.1111/jce.13190</doi><tpages>9</tpages></addata></record> |
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| subjects | Ablation Action Potentials Adult Aged Atrial Fibrillation - diagnosis Atrial Fibrillation - physiopathology Atrial Fibrillation - surgery Blanking blanking period Cardiac arrhythmia Chi-Square Distribution cryoballoon ablation Cryosurgery - adverse effects Disease-Free Survival early recurrence Electrocardiography, Ambulatory - methods Female Fibrillation Heart diseases Heart Rate Humans implantable loop recorder Implantation Italy Kaplan-Meier Estimate late recurrence Likelihood ratio Male Middle Aged Multivariate Analysis paroxysmal atrial fibrillation Predictive Value of Tests Proportional Hazards Models Pulmonary Veins - physiopathology Pulmonary Veins - surgery Recurrence Reproducibility of Results Retrospective Studies Risk Factors Signal Processing, Computer-Assisted Success Telemetry Time Factors Treatment Outcome |
| title | Recurrences in the Blanking Period and 12‐Month Success Rate by Continuous Cardiac Monitoring After Cryoablation of Paroxysmal and Non‐Paroxysmal Atrial Fibrillation |
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