Early recurrence of atrial arrhythmia and healthcare utilization during the 8-week blanking period following catheter ablation of atrial fibrillation
Notice bibliographique
Résumé
Abstract Background The 2024 EHRA/HRS/APHRS/LAHRS expert consensus statement proposed an 8-week "blanking period" for clinical trials involving catheter ablation of atrial fibrillation (AF), in which recurrences are not seen as a failure of treatment. However, the relationship between early recurrence of atrial arrhythmia and clinical events during the first 8 weeks following catheter ablation is not well defined. Purpose To study the association between recurrence of atrial arrhythmia in the first 14 days following catheter ablation of AF and healthcare utilization in the first 8 weeks following ablation. Methods We analyzed prospectively collected data from participants enrolled in the IMPROVE-PVI randomized trial testing colchicine 0.6 mg twice daily vs. placebo for 10 days following catheter ablation of AF. All participants received a 14-day Holter immediately following ablation. Recurrence of atrial arrhythmia was defined as Holter-documented AF, atrial flutter, or atrial tachycardia >30 seconds, and healthcare utilization was defined as any of emergency department visit, cardiovascular hospitalization, cardioversion, or repeat ablation. Blinded adjudicators assessed arrhythmias and outcomes. We built regression models to estimate the association between early recurrence of atrial arrhythmia and healthcare utilization. Results We analyzed data from 194 patients who wore a Holter immediately following catheter ablation of AF (median age 61 years, 22% female, 70% first procedure). The median HATCH score (hypertension: 1, age≥75 years: 1, transient ischemic attack or stroke: 2, chronic obstructive pulmonary disease [COPD]: 1, heart failure: 2) was 1 (interquartile [IQR] range, 0-1; range, 0-5), and 144 patients (74%) were discharged on an antiarrhythmic drug. During a median monitoring duration of 13 days, 61 patients (31%) had recurrent atrial arrhythmia. A total of 25 patients (13%) had a healthcare utilization event in the first 8 weeks following catheter ablation. Adjusted for the HATCH score, early recurrence of atrial arrhythmia was significantly associated with healthcare utilization (adjusted odds ratio 6.21, 95% confidence interval 2.49-15.51), as was higher burden of AF (per 1%-increase in AF burden, adjusted odds ratio 1.03, 95% confidence interval 1.01-1.05). Colchicine did not reduce early recurrence of atrial arrhythmia (hazard ratio 0.98, 95% confidence interval 0.59-1.61), nor did it reduce healthcare utilization within 8 weeks of ablation (hazard ratio 0.92, 95% confidence interval 0.42-2.02). Conclusions Nearly 1 in 3 patients had early recurrence of atrial arrhythmia in the first 14 days following catheter ablation of AF. More than 1 in 8 patients experienced a clinical meaningful event during the 8-week "blanking period" following catheter ablation, which was largely driven by early recurrence of atrial arrhythmia. Colchicine reduced neither early recurrence of atrial arrhythmia nor healthcare utilization.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».