Early Recurrence Is Reliable Predictor of Late Recurrence After Radiofrequency Catheter Ablation of Atrial Fibrillation

OBJECTIVES This study aimed to compare the risk of late recurrence in patients with and without early recurrence. BACKGROUND Early recurrence of atrial fibrillation (AF) or atrial tachycardia (AT) after radiofrequency catheter ablation (RFCA) in AF patients is known to be a transient phenomenon. The theoretical basis of the blanking period is based on such observations. However, the clinical implications of early recurrence need further validation. METHODS Consecutive RFCA cases in a tertiary hospital were analyzed. Early recurrence was defined as any AT or AF event occurring within 90-days post-RFCA. Early recurrence as AT and AF were also analyzed separately. RESULTS A total of 3,120 patients underwent RFCA. Early recurrence occurred in 751 patients (24.1%). Patients who experienced early recurrence had a larger left atrium, worse hemodynamics in the left atrial appendage, and a higher prevalence of nonparoxysmal AF and heart failure. Among patients who experienced early recurrence, 69.6% of patients eventually had late recurrence. Early recurrence was associated with a 4.3- and 3.6-fold increase in the risk of late recurrence after single and multiple procedures, respectively. After multivariate adjustment, early recurrence was an independent risk factor for late recurrence with 3.6- and 2.8-fold increase in the risk of late recurrence after single and multiple procedures, respectively. Early recurrence AT had a lower risk of late recurrence compared with early recurrence AF. CONCLUSIONS Early recurrence was a reliable predictor for late recurrence. The clinical significance of the blanking period in the current guidelines may need to be revisited. (C) 2021 by the American College of Cardiology Foundation.