Spontaneous Sinus Rhythm Restoration Within the Blanking Period as a Predictor of Late Recurrence After Catheter Ablation of Persistent Atrial Fibrillation

Aim - Various ablation strategies have been developed for persistent atrial fibrillation (AF), but there is no standardized management for early and late post-procedural management periods. The clinical benefits of spontaneous restoration of sinus rhythm (SR) during the blanking period, without electrical cardioversion at the end of the procedure, remain unknown. Objectives - The primary goal of our prospective observational cohort study was to determine the proportion of patients who achieve SR spontaneous restoration during the 3-month blanking period. The secondary goal was to assess predictors of long-term AF-free survival following ablation for persistent AF, with a particular focus on the role of spontaneous SR restoration during the procedure and after the 3-month blanking period. Materials and Methods – This was an observational, prospective, monocentric, cohort trial designed to assess arrhythmia-free survival during a median 17.8-month follow-up after catheter ablation (CA) for persistent AF without electrical cardioversion at the end of the procedure. The study recorded spontaneous SR restoration at the end of the 3-month blanking period and reported supraventricular arrhythmia recurrence and/or continuation during the follow-up. Results. Out of 213 patients included in the prospective cohort, 60 patients (28.2%) achieved SR restoration during the CA procedure. Among patients with arrhythmia continuation at the end of the procedure, spontaneous SR restoration was observed in 68 patients (44.4%) at the end of the 3-month blanking period. Lack of spontaneous SR restoration during the blanking period (OR=2.25, 95%CI:1.12-3.84) and ablation of complex fractionated atrial electrograms (OR=2.25, 95%CI:1.09-4.65) were found to be independent predictors of arrhythmia recurrence or continuation during the median 17.8-month follow-up. SR restoration during the CA procedure was not associated with arrhythmia-free survival during the long-term follow-up. Conclusions. This study evaluated a novel approach of tolerating arrhythmia continuation after CA for persistent AF and avoiding electrical cardioversion. Spontaneous SR restoration at the end of the 3-month blanking period is frequent and an independent predictor of arrhythmia-free survival during the long-term follow-up. Conclusion This study evaluated a novel approach of tolerating arrhythmia continuation after CA for persistent AF and avoiding initial electrical cardioversion. Spontaneous SR restoration at the end of the 3-month blanking period is frequent and an independent predictor of arrhythmia-free survival during the long-term follow-up.