Blanking Period Events Predict Long‐Term Recurrence After Substrate Modification Ablation for Atrial Fibrillation

BACKGROUND: The prognostic significance of blanking period arrhythmic events following extensive substrate modification ablation, such as the STABLE-SR procedure, remains inadequately defined. METHODS: In this single-center retrospective study, we analyzed data from 411 consecutive patients with non-paroxysmal atrial fibrillation (AF) undergoing first-time catheter ablation using the STABLE-SR technique. The incidence and characteristics of blanking period events (within 3 months post-ablation) were assessed. All patients were followed for 1 year to determine AF recurrence. Univariable and multivariable Logistic regression analyses were performed to identify predictors of recurrence. RESULTS: Among the 373 patients who completed follow-up, blanking period events occurred in 106 patients (28.4%). The 1-year recurrence rate was significantly higher in patients with blanking period events compared to those without (46.2% vs. 16.9%, p < 0.001). Multivariable analysis identified the presence of any blanking period event (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.22-6.11, p = 0.014), adjunctive cavotricuspid isthmus ablation (OR 1.91, 95% CI 1.01-3.36, p = 0.047), and the need for end-procedural electrical cardioversion (OR 3.10, 95% CI 1.01-9.48, p = 0.047) as independent predictors of long-term recurrence. CONCLUSIONS: In patients undergoing STABLE-SR ablation for non-paroxysmal AF, arrhythmias during the blanking period are common and constitute the strongest independent predictor of 1-year recurrence. Specific procedural characteristics further stratify recurrence risk.