Impact of shortening the blanking period to 8 weeks after PVI: Insights from COMPARE-CRYO using continuous rhythm monitoring

Salik Ur Rehman Iqbal; Thomas Kueffer; Sven Knecht; Patrick Badertscher; Jens Maurhofer; Philipp Krisai; Corinne Jufer; Gregor Thalmann; Nikola Kozhuharov; Valon Spahiu; Dik Heg; Helge Servatius; Hildegard Tanner; Michael Kühne; Laurent Roten; Christian Sticherling; Tobias Reichlin; COMPARE-CRYO Trial investigators

doi:10.1016/j.hrthm.2024.12.013

Impact of shortening the blanking period to 8 weeks after PVI: Insights from COMPARE-CRYO using continuous rhythm monitoring

Heart Rhythm. 2024 Dec 13:S1547-5271(24)03658-0. doi: 10.1016/j.hrthm.2024.12.013. Online ahead of print.

Authors

Salik Ur Rehman Iqbal¹, Thomas Kueffer¹, Sven Knecht², Patrick Badertscher², Jens Maurhofer¹, Philipp Krisai², Corinne Jufer¹, Gregor Thalmann¹, Nikola Kozhuharov¹, Valon Spahiu¹, Dik Heg³, Helge Servatius¹, Hildegard Tanner¹, Michael Kühne², Laurent Roten¹, Christian Sticherling², Tobias Reichlin⁴; COMPARE-CRYO Trial investigators

Affiliations

¹ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
² Department of Cardiology, University Hospital Basel, Basel, Switzerland.
³ Department of Clinical Research, University of Bern, Bern, Switzerland.
⁴ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: tobias.reichlin@insel.ch.

PMID: 39675650
DOI: 10.1016/j.hrthm.2024.12.013

Abstract

Background: Early recurrences of atrial tachyarrhythmias (ERATs) after pulmonary vein isolation (PVI) are common. While many correlate to late recurrences (LRs), some do not. The impact of ERATs timing is difficult to assess with noninvasive Holter monitoring because of undersampling. The recommended duration of the blanking period (BP) was recently shortened from 90 days to 8 weeks.

Objective: The purpose of this study was to evaluate the impact of ERATs timing after PVI and the effect of a shorter BP by using implantable cardiac monitors for continuous rhythm monitoring.

Methods: This is a prespecified substudy of the Comparison of the POLARx and the Arctic Front cryoballoon for pulmonary vein isolation in patients with symptomatic paroxysmal atrial fibrillation (COMPARE-CRYO) study, which enrolled patients with paroxysmal atrial fibrillation undergoing cryoballoon ablation. All patients underwent implantable cardiac monitor implantation, and the BP was 90 days.

Results: A total of 5285 ERATs episodes occurred in 117 of 201 patients (58%). Freedom from LR was 82% vs 37% in patients without vs with ERATs (P<.001). When patients were classified according to their last episode of ERATs occurring between days 0 and 30, between days 31 and 60, and between days 61 and 90, freedom from LR was 60%, 56%, and 11%, respectively (P<.001). Seven of 201 patients (3.4%) had AF recurrence in the third month after ablation, but not between days 91 and 365, which reclassifies them from ablation success to ablation failure with the shortened 8-week BP.

Conclusion: ERATs after PVI is common. The presence of ERATs in the third month after PVI was highly predictive of ablation failure, supporting the shortening of the BP to 8 weeks; however, the shorter BP reclassifies only 7 (3.4%) of patients to ablation failure instead of ablation success.

Keywords: Atrial fibrillation; Atrial fibrillation burden; COMPARE-CRYO; Early recurrence of atrial fibrillation; Implantable cardiac monitor.