Introduction & Hypothesis: Early recurrence (ER) of atrial tachyarrhythmia (ATA) is common after atrial fibrillation ablation. There is well unknown about current guidelines of blanking period after maze procedure. We aimed to investigate the significance of ER after maze procedure is a predictor of late recurrence (LR) and determine whether it varies according to timing.
Methods: From 2009 to 2016, a total of 290 patients underwent the open heart surgery with concomitant maze procedure were analyzed. Data were obtained from 12-lead electrocardiograms and Holter monitoring during follow-up. Patients with atrial ATA ≥30 seconds within post procedure 3 month were stratified according to the timing of ER.
Results: A total of 146 patients (50.3%) experienced their last episode of ER during the first the first (n=82), second (n=15), or third (n=49) month of the 3-month blanking period. One-year freedom from ATAs was 97.7% in patients without ER compared with 96.9%, 76.9%, and 10.4% in patients with ER 1, 2, and 3 months after index procedure, respectively (P<0.001). Receiver operating curve analyses showed a strong correlation between the timing of ER and late recurrence (area under the curve, 0.84, p<0.001, cut-off value: 58 days). Hazard ratios about LR according to timing of the last episode of ER 1, 2, and 3 months were 1.45, 13.7, and 89.86, respectively (figure).
Conclusions: Our study validates the blanking period after maze procedure for AF. As about 90% of patients with ER during the last 3 months post maze procedure experience late recurrence by 1 year, we put into question the 90-day cut-off value. Randomized trials required to assess the shorter blanking period on clinical outcomes after ablation of AF.