Optimized Length of Blanking Period after Catheter Ablation of Persistent Atrial Fibrillation

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Background: Mechanisms and implications of early recurrence (ER) within a blanking period are not clear, and the theoretically optimal length of a blanking period has been still debatable. Methods: Consecutive 206 patients (age: 62±9 years) with persistent AF [AF duration: 70±75 months, LA diameter: 47±5 mm] underwent the initial ablation procedure for the anatomical bi-atrial linear ablation after the encircling PV isolation. Early and late recurrences (LR) were defined as a documented episode of AF or atrial tachycardia (AT) within and more than two months after the initial ablation procedure, respectively. Results: ER occurred in 115 patients (56%) at a mean of 9±1 days after the initial procedure. During follow-up of 426±223 days after the initial procedure, 98 patients (48%) experienced late recurrences at mean of 169±156 days after the initial procedure. Of the 98 patients with LR, 72 patients had ER. ROC curve analysis revealed an optimal cut-off value for the length of a blanking period was 36 days after the initial procedure (sensitivity: 94% and specificity: 62%). Conclusions: The results of this study suggested that the optimal length of the post-ablation blanking period was 36 days after the initial ablation session in persistent AF. A 36-day-long blanking period could best pick out ER not related with LR and exclude ER related with LR as much as possible.