Incidence, timing and impact of early recurrence after pulsed filed ablation - insights from the SINGLE-SHOT CHAMPION trial using Continuous rhythm monitoring
S Iqbal, T Kueffer, T Storz, P Badertscher, S Knecht, N Kozhuharov, P Krisai, C Jufer, J Maurhofer, H Servatius, H Tanner, M Kuhne, L Roten, C Sticherling, T ReichlinAbstract
Background
Early recurrence of atrial tachyarrhythmia (ERAT) after pulmonary vein isolation (PVI) using thermal energies is common. Because ERAT may resolve over time, a blanking period (BP) is used after PVI. The incidence and impact of ERAT after pulsed field ablation (PFA) is unclear.
Methods
Patients with symptomatic paroxysmal AF were randomized 1:1 to PVI using PFA or Cryoballoon ablation (CBA). All patients received an implantable cardiac monitor (ICM) at the time of ablation and the BP duration was 90 days.
Results
Incidence of ERAT was 39.6% after PFA (n=105) and 60% after CBA (n=105, p=0.004), and median AF-Burden in the BP was 0.0% (IQR 0.0-0.2) vs. 0.2% (IQR 0-1.2, p=0.001) (Figure 1-2). When patients were classified according to ERAT within first 0-30 days vs. 31-90 days, freedom from recurrence at 12 months was 50% vs. 15% for PFA (p<0.001) and 50% vs 5% for CBA (p<0.001). Compared to no ERAT, ERAT beyond 30 days was associated with increased healthcare utilization (AF-related hospitalizations and redo ablations) in both PFA (p<0.001) and CBA (p<0.001). With a blanking period duration of 0, 30, 60 or 90 days, reported one-year success rates increased from 55% to 58%, 61% and 63% for PFA and from 37% to 47%, 49% and 49% for CBA.
Conclusion
ERAT incidence is lower following PFA versus CBA. Whereas ERAT confined to the first 30 days usually resolves, ERAT beyond 30 days rarely do and is associated with increased healthcare utilization, supporting the rationale for a shorter BP.