Defining the blanking period duration after cryoballoon pulmonary vein isolation in patients taking an antiarrhythmic drug

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
D Musat ◽  
NS Milstein ◽  
M Saberito ◽  
A Bhatt ◽  
M Habibi ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Antiarrhythmic Drug ◽  
High Likelihood ◽  
Loop Recorder ◽  
Funding Sources ◽  
Very High ◽  
Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: None. Background Cryoballoon pulmonary vein isolation (CB) is an accepted method for ablation in patients with atrial fibrillation (AF). A three-month blanking period (BP) is commonly used in clinical trials and practice. However, the actual BP duration in patients (pts) on an antiarrhythmic drug (AAD) at time of ablation remains undefined. Objective To objectively define the BP duration in pts undergoing CB while taking an AAD. Methods We enrolled consecutive pts with AF who had CB PVI while on an AAD. All pts had an implantable loop recorder (ILR). We prospectively followed all pts and determined the time to last AF episode during the 90-day post-PVI BP. This was then correlated with likelihood of having an AF recurrence between 3-12 months post-PVI. Results The cohort included 92 pts (66 ± 10 years; 62 [67%] male; 33 [36%] PAF; CHA2DS2-VASc 2.6 ± 1.7). AADs used included dofetilide (42), dronedarone (14), amiodarone (25), sotalol and propafenone (3 each), and flecainide (5). The AAD was stopped at a median of 80 [36, 105] days post-PVI.  We defined 4 distinct groups: (1) no AF in 90-day BP (n = 45 [49%]); (2) last AF within 30 days of PVI (n = 17 [18%]); (3) last AF within 60 days of PVI (n = 13 [15%]); and (4) last AF within 90 days of PVI (n = 17 [18%]). Following the 90-day BP, 47 (51%) pts had a recurrence of AF. Once recurrent AF was observed > 30 days post-ablation, patients had high likelihood of having a long term AF recurrence (p = 0.037, Figure). Conclusion Our data suggest that the optimal BP duration in AF patients undergoing CB PVI while taking an AAD is 30 days. An AF recurrence after 30 days is associated with a very high likelihood of recurrent AF during longer-term follow-up. Abstract Figure.

scholarly journals Is the optimal blanking period duration after cryoballoon pulmonary vein isolation impacted by use of antiarrhythmic drugs?

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
D Musat ◽  
NS Milstein ◽  
M Saberito ◽  
A Bhatt ◽  
M Habibi ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Loop Recorder ◽  
Funding Sources ◽  
Very High ◽  
Period Duration ◽  
Af Recurrence ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background Cryoballoon pulmonary vein isolation (CB) is an accepted method for ablation in patients with atrial fibrillation (AF). A three-month blanking period (BP) is commonly used in clinical trials and practice. However, when the optimal BP duration differs in patients (pts) on or off an antiarrhythmic drug (AAD) at time of ablation remains undefined. Objective To compare the BP duration in pts undergoing CB while either taking or not taking an AAD. Methods We enrolled consecutive pts with AF who had CB PVI while on an AAD. All pts had an implantable loop recorder (ILR). We prospectively followed all pts and determined the time to last AF episode during the 90-day post-PVI BP. This was then correlated with likelihood of having an AF recurrence between 3-12 months post-PVI. Results The cohort included 164 pts (66 ± 9 years; 97 [60%] male; 90 [55%] PAF; CHA2DS2-VASc 2.7 ± 1.7). Ablation was performed with 92 (56%) pts taking an AAD, which was stopped at a median of 80 [36, 105] days post-PVI. We defined 4 distinct groups: (1) no AF in 90-day BP (n = 75 [46%]); (2) last AF within 30 days of PVI (n = 32 [20%]); (3) last AF within 60 days of PVI (n = 17 [10%]); and (4) last AF within 90 days of PVI (n = 40 [24%]). Following the 90-day BP, 81 (49%) pts had a recurrence of AF. Long-term freedom from recurrent AF was similar in pts who did and did not use an AAD, irrespective of BP duration (Figure). Conclusion Our data suggest that the optimal BP duration in AF patients undergoing CB PVI while taking an AAD is 30 days. An AF recurrence after 30 days is associated with a very high likelihood of recurrent AF during longer-term follow-up, irrespective of whether an AAD is being used or not. Abstract Figure.

scholarly journals Does use of an antiarrhythmic drug prior to cryoballoon pulmonary vein isolation impact the duration of the post-ablation blanking period?

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Saberito ◽  
N Milstein ◽  
A Bhatt ◽  
M Habibi ◽  
T Sichrovsky ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Antiarrhythmic Drug ◽  
Loop Recorder ◽  
Funding Sources ◽  
Long Term Follow Up ◽  
The Impact ◽  
First 90 Days ◽  
Af Recurrence

Abstract Background At time of cryoballoon (CB) pulmonary vein isolation (PVI), some patients with atrial fibrillation (AF) are on an antiarrhythmic drug (AAD) while others are not. The impact of AAD use at time of CB PVI on the duration of post-ablation blanking period (BP) is unknown. Objective To determine whether the optimal BP duration differs between pts who were and were not taking an AAD at time of CB PVI. Methods We enrolled consecutive pts with AF who had initial CB PVI; all pts had an implantable loop recorder (ILR). We prospectively followed all pts and determined the time to last AF episode during the 90-day post-PVI BP. This was then correlated with likelihood of having an AF recurrence between 3–12 months post-PVI. Results The cohort included 165 pts (66±9 years; 99 [60%] male; 91 [55%] PAF; CHA2DS2-VASc 2.7±1.6). An AAD was being used at some point prior to ablation in 120 (73%) pts. An AAD was being used at time of CB PVI in 92 (77%) of these 120 pts; this was stopped at a median of 80 [36, 105] days post-PVI. We defined 4 distinct groups: (1) no AF in 90-day BP (n=75 [45%]); (2) last AF within 30 days of PVI (n=32 [19%]); (3) last AF within 60 days of PVI (n=17 [10%]); and (4) last AF within 90 days of PVI (n=41 [25%]). Patients not exposed to an AAD prior to CB PVI had significantly lower likelihood of having no AF in the first 90-days post ablation (p=0.004, Figure). In contrast, if AF was observed post-ablation, as time from ablation to recurrence increased, so did likelihood of long-term failure from ablation (Figure); this relationship was not impacted by use of an AAD. Conclusion The best long-term outcomes post CB PVI are seen in pts who had no prior exposure to an AAD and had no AF within the first 90 days of ablation. Subsequently, as the time from ablation to AF recurrence increased within the 90-day BP, so did likelihood of recurrent AF during long-term follow-up, irrespective of whether an AAD was or was not used. FUNDunding Acknowledgement Type of funding sources: None.

P1913Implantable Loop Recorder Detected Pattern of Atrial Fibrillation Recurrence Following Cryoballoon Pulmonary Vein Isolation in Patients with Persistent Atrial Fibrillation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Musat ◽  
N Milstein ◽  
R Shaw ◽  
A Bhatt ◽  
M Preminger ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Persistent Atrial Fibrillation ◽  
Limited Data ◽  
Loop Recorder ◽  
Long Term Follow Up ◽  
Af Recurrence

Abstract Background Cryoballoon (CB) pulmonary vein isolation (PVI) is increasingly being used in patients (pts) with persistent atrial fibrillation (AF). However, there are limited data about the pattern of atrial fibrillation (AF) recurrence in these pts. Objective To assess, using an implantable loop recorder (ILR), the patterns of AF recurrence following CB PVI in pts with persistent atrial fibrillation. Methods We enrolled consecutive pts with persistent AF ablation undergoing their first CB ablation. Other cavotricuspid isthmus ablation when indicated, no other ablation was performed. A Reveal LINQ ILR (Medtronic) was implanted <3 months following ablation; all pts had a minimum of 1-year follow-up. The recurrence of any atrial arrhythmia was determined and adjudicated; 4 distinct AF patterns were characterized (Figure). Results We studied 64 pts (66±9 years; 50 [78%] male; CHA2DS2-VASc 2.6±1.9) with persistent AF; 52 (81%) pts were on an antiarrhythmic drug (AAD) peri-ablation. During 803±361 days of follow-up, 33 (52%) pts had their 1st AF recurrence 91–365 days post-ablation and another 17 (27%) pts had their 1st AF recurrence >365 days post-ablation. No AF was seen in 14 (31%) pts. Most pts (33 of 50, 66%) with AF recurrence presented with 1 of 3 distinct patterns of paroxysmal AF (Figure), which ranged from 22 min to 124 hours. In 2/3 of these pts, all AF recurrences lasted <24 hours. Only 17 (34%) pts recurred with persistent AF. Conclusion Following single CB PVI, most pts with persistent AF remained free of persistent AF during long-term follow-up. Most pts with recurrent AF have 1 of 3 distinct patterns with episodes commonly last <24 hours. These data suggest that CB PVI ablation may halt AF progression in pts initially presenting with persistent AF.

scholarly journals Defining the optimal blanking period duration after cryoballoon pulmonary vein isolation in patients with atrial fibrillation who have never been treated with an antiarrhythmic drug

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
N Milstein ◽  
M Saberito ◽  
A Bhatt ◽  
M Habibi ◽  
T Sichrovsky ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Antiarrhythmic Drug ◽  
Loop Recorder ◽  
Term Outcome ◽  
Long Term Outcome ◽  
First 90 Days ◽  
Af Recurrence

Abstract Background Cryoballoon (CB) pulmonary vein isolation (PVI) is an approved method for ablation in patients with paroxysmal (PAF) or persistent (PeAF) atrial fibrillation (AF). Although the first 90 days post-ablation are considered within the blanking period (BP), the optimal duration of the BP remains undefined. Purpose To objectively define the BP duration in pts undergoing CB PVI by evaluating a cohort never treated with an antiarrhythmic drug (AAD). Methods We enrolled consecutive pts with either PAF or PeAF who underwent initial CB PVI; all pts had an implantable loop recorder (ILR) for long-term ECG monitoring. No pt received an AAD either before or after ablation. We determined the time to last AF episode within the first 90 days of ablation. We then correlated this to the likelihood a patient had recurrent AF between 91 and 365 days of ablation. Results There were 45 pts (67±8 years; 26 [58%] male; 40 [89%] PAF; CHA2DS2-VASc 2.6±1.3). We defined 4 distinct groups post ablation based on whether or not they had AF in the BP: (1) no AF days 0–90 (n=19 [42%]), (2) last AF days 0–30 (n=11 [24%]), (3) last AF days 31–60 (n=3 [7%]), and (4) last AF days 61–90 (n=12 [27%]). After the 90-day BP, 15 (33%) pts had AF recurrence. Pts with no AF and those with AF only within 30 days of ablation had similar long-term outcome; however, recurrent AF more than 32 days after ablation predicted long-term ablation failure (Figure). Conclusion The post CB PVI blanking period is just a month. AF recurrences beyond a month in patients not on an AAD are associated with AF recurrence in the majority of pts. FUNDunding Acknowledgement Type of funding sources: None. Blanking Group by AF Recurrence

scholarly journals Derivation and validation of a VISITAG™-guided contact force ablation protocol for pulmonary vein isolation

2017 ◽  
Author(s):  
David R. Tomlinson
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
Stability Range ◽  
Time Integral ◽  
Long Term Follow Up ◽  
Force Time ◽  
Af Recurrence

AbstractAims Following radiofrequency (RF) pulmonary vein isolation (PVI), atrial fibrillation (AF) recurrence mediated by recovery of pulmonary vein (PV) conduction is common. I examined whether comparative VISITAG™ (Biosense Webster Inc.) data analysis at sites showing intra-procedural recovery of PV conduction versus acutely durable ablation could inform the derivation of a more effective VISITAG™-guided contact force (CF) PVI protocol.Methods and results Retrospective analysis of VISITAG™ Module annotated ablation site data in 10 consecutive patients undergoing CF-guided PVI without active VISITAG™ guidance. Employing 2mm positional stability range and lenient CF filter (force-over-time 10%, minimum 2g), inter-ablation site distance >10-12mm, adjacent 0g-minimum CF and short RF duration (3-5s) were associated with intra-procedural recovery of PV conduction. A VISITAG™-guided CF PVI protocol was derived employing ≤6mm inter-ablation site distances, minimum target ablation site duration ≥9s / force time integral (FTI) 100gs and 100% 1g-minimum CF filter. Seventy-two consecutive VISITAG™-guided CF PVI procedures were then undertaken using this protocol, with PVI achieved in all utilising 23.8[8.4] minutes total RF (30W, 48°C, 17ml/min, continuous RF application). Following protocol completion, acute intra-procedural spontaneous / dormant recovery of PV conduction requiring touch-up RF occurred in 1.4% / 1.8% of PVs, respectively. At 14[5] months’ follow-up in all 34 patients with paroxysmal AF ≥6 months’ post-ablation, 30 (88%) were free from atrial arrhythmia, off class I/III anti-arrhythmic medication.Conclusion VISITAG™ provides means to identify and then avoid factors associated with intra-procedural recovery of PV conduction. This VISITAG™ Module-guided CF PVI protocol demonstrated excellent intra-procedural and long-term efficacy.Condensed abstract Following CF-guided PVI, retrospective VISITAG™ Module analyses permitted the identification of ablation parameters associated with intra-procedural recovery of PV conduction. The derived VISITAG™ Module-guided CF PVI protocol employed short over RF duration yet proved efficient at achieving PVI acutely, with long-term follow-up demonstrating high clinical efficacy.

Abstract 1737: A Strategy for Continuous ECG Recording in Patients Post Pulmonary Vein Isolation for Atrial Fibrillation

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Andrew D Choi ◽  
Sandeep Joshi ◽  
Daniel Marrero ◽  
Farbod Raiszadeh ◽  
Apurva Badheka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Ecg Monitoring ◽  
Loop Recorder ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Procedural Success

Introduction : Following pulmonary vein isolation (PVI) for management of atrial fibrillation (AF), may centers obtain continuous ECG recordings for several weeks in order to detect early recurrences of AF. However, the implications of early AF following PVI in an individual patient are unknown as is the optimal duration of monitoring in these patients. Methods : We evaluated 72 pts (60 ± 11 yrs, 67% male, 67% paroxysmal AF) who underwent PVI and were followed for >= 6 months. At hospital discharge, all pts were fitted with an external event loop recorder (LifeWatch AF Express) for 14 weeks for the continuous automatic detection of AF (defined as an episode lasting >= 30 sec). Clinical follow-up occurred at 1, 3 and 6 months post-PVI; procedural success was defined by freedom from AF at the 6 month follow-up. Results : During the 14-week loop monitoring period, no AF was observed in 25 (35%) patients. Only 2 of these pts subsequently developed AF; in both cases, AF occurred 3– 6 months post-PVI. In contrast, 47 (65%) patients had at least 1 AF episode, most commonly (39/47 pts, 83%) within the first 2 weeks of PVI. In fact, absence of AF during the first 2-weeks of loop monitoring identified a cohort of patients with high likelihood of procedural success at 6 months (Figure ). Conclusions : Our data support a rationale for at least 2-weeks of continuous automatic loop ECG monitoring in all pts post-PVI. Patients without AF during this period can be expected to have excellent long-term outcome. Longer periods of ECG monitoring may be better limited to patients in whom AF is observed during initial 2-week monitoring.

scholarly journals Long-term follow-up of thoracoscopic ablation for long-standing persistent atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Harlaar ◽  
M.A.P Oudeman ◽  
S.A Trines ◽  
G.S De Ruiter ◽  
M Khan ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Pulmonary Vein ◽  
Atrial Arrhythmia ◽  
Wilcoxon Test ◽  
Continuous Group ◽  
Loop Recorder ◽  
Long Term Follow Up ◽  
Rhythm Monitoring

Abstract Background Catheter ablation in patients with long-standing persistent AF (LSPAF) remains challenging and often requires repeated procedures with variable results. We report long-term outcomes of a bipolar thoracoscopic pulmonary vein and left atrial posterior wall ablation for LSPAF, and compare continuous and interval rhythm monitoring. Methods Seventy-seven LSPAF patients who underwent thoracoscopic pulmonary vein and box isolation between 2009–2017 in two Dutch centers were included. Follow-up consisted of continuous rhythm monitoring using an implanted loop recorder or 24-h Holter at 3/6/12/24/60 months. Results Mean age was 59±8 years with a median AF duration of 3.8 [1.2–6.3] years. In the total cohort, at 2-year follow-up, 86.0% of patients were in sinus rhythm, 12.3% were in paroxysmal AF and 1.6% in persistent AF. At 5 years, 62.9% of patients were in sinus rhythm, 20.0% in paroxysmal AF, 14.3% in persistent AF and 2.9% was experiencing atrial flutter. Continuous rhythm monitoring was performed in 46% of patients. Comparing continuous and interval rhythm monitoring, freedom from any atrial arrhythmia episode at 2- and 5 years was 60.0% and 49.9% in the continuous group and 93.8% and 51.9% in the interval monitoring group, respectively (p=0.02, Breslow-Wilcoxon test). In patients with continuous rhythm monitoring the mean atrial arrhythmia burden was reduced from 99.1% preoperatively to 0.1% at the end of the blanking period and 7.3% at 2-year follow-up. Conclusions Thoracoscopic box ablation is highly effective in restoring sinus rhythm at medium term follow-up. However, it is not a curative treatment as demonstrated by the 50% arrhythmia-free survival at long-term follow-up. Whether this is due to the progressive nature of AF needs further investigation. Continuous rhythm monitoring shows earlier recurrence detection with a potential early treatment adaptation. Funding Acknowledgement Type of funding source: None

Abstract 15934: Comparison of Atrial Fibrillation Burden Reduction in Patients With Paroxysmal and Persistent Atrial Fibrillation Undergoing Cryoballoon Pulmonary Vein Isolation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Dan L Musat ◽  
Nicolle S Milstein ◽  
Jacqueline Pimienta ◽  
Advay Bhatt ◽  
Tina C Sichrovsky ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Persistent Atrial Fibrillation ◽  
Loop Recorder ◽  
Similar Reduction ◽  
Af Ablation ◽  
Ablation Success ◽  
One Year ◽  
Af Recurrence

Background: Pulmonary vein isolation (PVI) is a cornerstone of atrial fibrillation (AF) ablation procedures to treat symptomatic AF. Ablation success is defined by absence of AF recurrence >30 seconds. However, reduction in AF burden (AFB) is also an important endpoint. Whether patients with paroxysmal (PAF) and persistent AF (PeAF) have similar reduction in AFB post-ablation is unknown. Objective: To compare the decrease in AFB following cryoballoon (CB) PVI in patients with PAF and PeAF. Methods: We enrolled consecutive pts with an implantable loop recorder (ILR) who subsequently underwent CB PVI. All patients were followed prospectively for at least one year, or until repeat ablation; we compared AFB pre and post-ablation. Results: The cohort included had 47 patients (66 ± 10 years; 32 [68%] male; PAF [n=23, 49%]; CHA 2 DS 2 -VASc 2.7 ± 1.7, 34 [72%] on AAD at the time of ablation). A median of 136 days [IQR 280, 73; minimum of 30 days] of ILR data pre-ablation were available. The median AFB for PAF was 4.7% [IQR 0.9, 14.8] and PeAF was 6.8% [IQR 1.1, 40.4]. After excluding a 3-month post-ablation blanking period, recurrent AF occurred in 12 (52%) PAF and 11 (46%) PeAF patients. The median AFB post-ablation for PAF and PeAF cohorts was 0.03%, [IQR 0, 0.3] and 0.04%, [IQR 0, 1.1], respectively. This represents a >99% reduction in AFB. Conclusion: Although 50% of patients undergoing CB PVI for PAF or PeAF had a recurrence of AF, there was >99% reduction in AFB in both groups. These data highlight the importance of using AFB burden as a marker of therapeutic efficacy post-AF ablation.

Sign in / Sign up

Export Citation Format

Share Document