Interesting article on Blanking Peri... - Atrial Fibrillati...
Interesting article on Blanking Period following AF ablation
Thanks for posting. Yes, many papers on this.
In a nutshell, what these papers say is that early occurrences during blanking are associated with late occurrences after blanking (ablation failure).
That really calls into question, the "Oh, that's normal, don't worry" advice often given to those with blanking episodes. It may be "normal" but it also significantly reduces your chance of a successful ablation.
That said, they really don't define "success" and ep's tend to be aggressive in terms of repeat ablations, at least here in the US. So if "failure" is defined as only one two afib episodes as year, I'll take that failure any day 
But one carry way, is not to take the blanking period lightly. It's not a free pass to go into afib without consequence. That's why you should take it super easy to give things the best chance of healing and the ablation the best chance of success. I'm 9 weeks post ablation and only now just getting back to normal activities and exercise.
My EP Prof Pierre Jaïs in Bordeaux gets quite exasperated with the whole '30 seconds or more of AF/AT within 12 months of an ablation being regarded as a 'failed' ablation. Both he and Sonny Jackman often argue this at meetings but dogma is what it is. As you say most folks - particularly those having PersAF prior - would take one or two short episodes of AF/AT per year as a resounding success. I know I would/will.
Heard good things about him How is his English btw, I called the office once, but never followed through.
My observations are that afib is in most cases is either undertreated or overtreated. And the same with ablations. Either they wait too long, or they do it too soon. A 30 second threshold for "failure" could translate into an unnecessary additional ablation.
Jim
His English is excellent Jim. Worried about potential long term adverse issues from overly aggressive ablation - not least preserving atrial transport - he is also very much an advocate of doing the least ablating possible to get the desired result. (Although that said, when in a full-blown high ventricular rate AF episode I would happily sign up to have my atria totally obliterated ! )
Sounds like my kind of ep. A minimalist Do you know if he use conscious sedation or just general anesthesia? If he does conscious sedation, I might just pack my beret, should I ever need a touch up
Jim
Hi again Jim, I've had conscious sedation for both of my ablations. Prof Jais really doesn't like to use GA. The biggest problem I had with going to France was communicating with the nurses ! Who despite the language barrier were very lovely by the way !
So he did the PVI under conscious sedation? Was it RF? Cryo? Pulse Field? I'm ready to learn a little French to communicate with the nurses if need be I just don't do well with GA or Propofol. It would be out of pocket, so I guess my new car can wait
2018 PVI using RF done with conscious sedation not GA.
2023 re-do using PFA (and RF just for flutter line) also done with conscious sedation not GA.
I got by fairly well with Google Translate with the nurses 👍
Funds put aside for a third go as and if needed - don't think I would have more than 3 though...
I don't know if all EP's in the US are like this, but mine said just take it easy for a week and then go back to normal. I wish I'd found this site and learned of the blanking period before going on a rather arduous hiking trip (hills so steep they just put in stairs) (very pretty though) too soon after my first ablation last year. I'm repeating the trip again next month (new family tradition) but my second ablation was in early February and I've given myself more time to heal (I've always healed slowly). My heart has been very quiet after this second ablation (unlike after the first), and it may be because I'm aware of the blanking period and have been modifying my activities with my heart in mind.
My ep told me I could resume full exercise in 10 days. He's young, he's never had an ablation and is so busy in the ep lab that he probably doesn't know exactly what we go through after he finishes with us 10 days, no way. It's nine weeks now and almost getting back to full exercise, but not quite.
Jim
There is one other VERY interesting comment in that report re continued use of Antiarrhythmic Drugs post the blanking period making a difference to the 1 year outcomes.
"Interestingly, more than half of the respondents keep AAD for the
duration of BP, particularly Class I AAD: it has to be noticed that continued AAD beyond BP in patients free of AF has been shown to improve 1-year outcomes15 but the value of AAD in the blanking period only is limited "
I will raise with EP as most tell you to come off after 3 months.
Yes, VERY interesting and thanks for pointing this out. I just read the source paper for that-- see link below.
At first glance, it was WOW, such a difference in repeat ablations between stopping AAD's at 12 months versus six. But unless I'm reading it wrong, if 12 months is the endpoint, isn't it more of a DUH, since if your're on an AAD, of course you have a better chance of not needing an ablation. For me at least, if I'm on Flecinide I just don't go into afib. I had an ablation to get off Flecainde Please let me know your take on the paper.
pubmed.ncbi.nlm.nih.gov/292...
Jim
most people get ablations because drugs have failed even if an ablation does not complexly cure af it may mean that it can be controlled by drugs so many are not having ablation because they want to get off drugs its because the dont work any more - clearly if your aim is simply to get of drugs that would not work !
In the US, ablations are offered even first line now, meaning even before drug therapy. Here, to have an ablation to get off the drugs is very common. That was my reason. And I ablated now, not just because I'm not crazy about the side effects, but because there is no guarantee my Flecainide will work forever. So being in my 70's, do I really want to have an ablation when it stops working which might be in my 80's?
But going back to the study, not helpful for me to make a decision whether to extend Flecainide past blanking or not, because no breakdown of how controlled the patients were pre-ablation on anti-arrythmic's, or even if they were on them at all, but I will look at it again.
Jim
Flecainide (100mg BID) worked well for me for 10 years (1 or 2 short episodes per year converted by extra 200mg of Flecainide in an hour or so).
First ablation (PVI Aug 2018) done when AF started rearing its head every month for first 6 months of 2018 PLUS extra Flecainide at onset no longer seemed to work. Did OK after that until Oct 2022 when I ran into an extended/persistent episode of some AF but mostly AT after a bad bout of Covid. After my second redo ablation early this year (03/01/23) I was supposed to stop Flecainide after 3 months but I won't be trying to stop it until 1 year has passed and even then will only taper very slowly keeping a close eye on things. Yes I'd like to ditch the Flecainide, but nowhere near as much as I want to ditch the AF/AT!
After an initial 3 day bout of tachychardia 6 weeks after ablation, I have been free of anything other than ectopics and a few 30 second runs of AF. I am nearly 11 months past ablation. My EP reduced my dose of sotolol but said he wanted to leave me on a reduced dose ‘ just incase’ . I am happy with this and to me it is a huge success whereas I know some people don’t consider it a success unless they are off the meds. I have had a long and difficult journey with AF and am glad for any respite I can get. X
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