Eric Rashba

Background: Atrial arrhythmias that recur within the first 3 months after atrial fibrillation (AF) catheter ablation are conventionally attributed to a “blanking period” and not classified as procedural failure. Accumulating evidence suggests that such early recurrences of atrial tachyarrhythmias (ERAT) may instead predict late recurrence, raising concern that the conventional 3‐month window overestimates the duration during which recurrences are benign. Objective: To assess the association between ERAT during each of the first 3 months after AF catheter ablation and late recurrence of atrial tachyarrhythmias (LRAT), and whether this association differs by ablation energy source. Methods: We searched Ovid MEDLINE, Embase, and Web of Science without restriction on date or publication status for studies of AF catheter ablation reporting ERAT during defined intervals of the blanking period, stratified by subsequent LRAT status. Ablation energy sources included radiofrequency, cryoballoon, and pulsed field. The exposure was ERAT during the first, second, and third months after ablation, and the outcome was LRAT. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using random‐effects models. Results: Twelve studies comprising 7,751 patients (2,505 with LRAT, 5,246 without) were included. Mean follow‐up was 22.0 months, mean age 60.7 years, 25.8% were women, 52.5% had paroxysmal AF, mean CHA ₂ DS ₂ ‐VASc score was 2.1, mean left atrial diameter 42.6 mm, and mean left ventricular ejection fraction 58.1%. ERAT was associated with subsequent LRAT, and the strength of this association increased across the blanking period: month 1 (12 studies; OR 1.76, 95% CI 1.01–3.08; p = 0.05), month 2 (10 studies; OR 3.46, 95% CI 2.15–5.57; p < 0.001), and month 3 (10 studies; OR 21.4, 95% CI 10.9–42.2; p < 0.001). The graded association was reproduced within the radiofrequency and cryoballoon subgroups. Conclusion: ERAT was associated with subsequent LRAT throughout the blanking period, with a graded relationship that strengthened month by month and was strongest in the third month. These findings support a blanking period shorter than the conventional 3 months.

Background: Colchicine is commonly used early after atrial fibrillation (AF) ablation to reduce inflammation and reduce AF recurrence, but there is limited long-term efficacy data. Objective: To evaluate the effect of low dose colchicine use on long-term AF recurrence after AF ablation. Methods: From 2013 to 2021, all AF ablations performed at a single tertiary care medical center were analyzed for colchicine use, clinical and procedural characteristics, and AF recurrence. The colchicine dose was 0.3-0.6 mg once daily for 30 days. The primary outcome was AF recurrence, defined as AF detection for more than 30 seconds after a three-month blanking period. Propensity score matching (PSM, 1:1 match) was performed using covariates that were significant predictors of AF recurrence in prior studies. The minimum duration of follow-up was 6 months. Kaplan-Meier analysis was conducted to assess time to AF recurrence in the entire cohort and the PSM cohort. Results: The study population consisted of 1568 AF ablations in 1412 patients (67% male, age 65 ± 7 years and mean follow up 34 ± 14 months); 78% of the patients received colchicine. Colchicine use was associated with decreased AF recurrence (HR 0.78, CI 0.63-0.96, p=0.022). After PSM there were 275 patients in each group. AF recurrence was lower with colchicine (HR 0.71, CI 0.53-0.96, p=0.026). Conclusions: Low dose colchicine use was associated with lower long-term AF recurrence after AF ablation. A randomized, placebo-controlled trial is warranted to confirm if low dose colchicine should be used routinely after AF ablation.

Background The benefit of implantable cardioverter defibrillator (ICD) therapy in patients who have heart failure with improved left ventricular ejection fraction (LVEF) to >35% after implantation (HFimpEF) is controversial. Methods Databases (Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar) were queried for studies of ICD patients that reported the association between HFimpEF and arrhythmic events (AEs), defined as the combined incidence of ventricular arrhythmias, appropriate ICD intervention and sudden cardiac death (primary composite endpoint). Results A total of 41 studies and 38,572 patients (11,135 with HFimpEF, 27,437 with persistent EF 35% and Conclusion HFimpEF is associated with reduced, but not eliminated, risk for AEs in patients with ICDs. The decision for replacing an ICD in lower risk subgroups should incorporate shared decision making based on risks for subsequent AEs and procedural complications.

Recent studies have questioned the role of implanted cardiac defibrillators (ICDs) in nonischemic cardiomyopathy (NICM). Cardiac resynchronization therapy (CRT) can be delivered by a pacemaker (CRT-P) or an ICD (CRT-D). This meta-analysis assessed the effect of CRT-P versus CRT-D on mortality in patients with NICM. Databases were searched for studies reporting the effect of CRT on all-cause mortality in patients with nonischemic cardiomyopathy (Ovid MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar, and EBSCO CINAHL). The primary endpoint was all-cause mortality. The minimum duration of follow-up required for inclusion was one year. The search was not restricted to time or publication status. The literature search identified 955 candidate studies, 15 studies and 22,763 patients were included. Mean follow-up was 53 months (17–100 months). CRT-D in NICM was associated with lower all-cause mortality (log HR − 0.169, SE 0.055; p = 0.002) compared to CRT-P. Heterogeneity: df = 15 (P 0.03), I2 = 43; test for overall effect: Z = − 3.043 (P = 0.002). CRT-D in NICM was associated with lower all-cause mortality than CRT-P.