Timing, Prevalence, and Impact of Early Recurrence of Atrial Tachyarrhythmias After Pulsed Field Ablation: Secondary Analysis of PULSED AF
Document Type
Conference Proceeding
Publication Date
5-2024
Publication Title
Heart Rhythm
Abstract
Background: Early recurrence of atrial tachyarrhythmias (ERATs) within three months following radiofrequency or cryoballoon catheter ablation for atrial fibrillation (AF) is common (w50% in trials with weekly monitoring of arrhythmias during the blanking period) and often considered transient. ERAT has been linked with early pro-arrhythmogenic processes after thermal ablation. However, pulsed field ablation (PFA) is a non-thermal energy source in which ERAT is not well described. Objective: To analyze ERAT in AF patients undergoing ablation using PFA in the PULSED AF trial. Methods: A total of 186 paroxysmal and 174 persistent AF patients were monitored immediately post ablation by weekly and symptomatic trans-telephonic monitoring (TTM) through 12 months, and 12-lead ECGs at 3, 6, and 12 months. This analysis was limited to 294 patients (154 paroxysmal, 140 persistent AF) that had ≥10 rhythm assessments during the 90-day blanking period. ERAT was defined as any instance of ≥30s of atrial fibrillation, atrial flutter, or atrial tachycardia on TTM or ≥10s on ECG, both within the blanking period. Late recurrence of atrial tachyarrhythmias (LRATs) was defined as observed atrial tachyarrhythmias between 90 days and 12 months. Results: Overall prevalence of ERAT was 27.1% in paroxysmal and 31.6% in persistent AF patients. Median time to first documented ERAT (i.e., ERAT onset) was 19 [5-56] days in paroxysmal and 7.5 [4-14] days in persistent AF patients. In patients with ERAT, 71% had ERAT onset within the first month post-procedure vs. 12% within the second and 17% in the third month. Presence of ERAT was associated with LRAT in paroxysmal (HR 6.4 (95%c.i. 3.6-11.3)) and persistent (HR 3.8 (95%c.i. 2.2-6.6)) AF patients. Yet, in 29.4% of paroxysmal and 34.3% of persistent AF patients with ERAT, LRAT was not observed. Conclusion: The prevalence of ERAT post AF ablation with PFA is lower compared to historic rates of thermal energies. However, the concept of a blanking period post PFA is still valid as 1/3rd of patients with ERAT do not develop LRAT during follow-up and may not need re-ablation.
Volume
21
Issue
5S
First Page
S114
Last Page
S115
Recommended Citation
Boersma LV, Natale A, Haines DE, De Lurgio DB, Sood N, Marchlinski FE, et al. Timing, prevalence, and impact of early recurrence of atrial tachyarrhythmias after pulsed field ablation: secondary analysis of PULSED AF. Heart Rhythm. 2024 May;21(5S):S114-S115. doi:10.1016/j.hrthm.2024.03.1804
DOI
10.1016/j.hrthm.2024.03.1804
Comments
Heart Rhythm Society Annual Meeting, May 16-19, 2024, Boston, MA