PMC:6019327 / 600221-602227 JSONTXT

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has long been recognized that in the weeks immediately following AF ablation, early recurrences of atrial arrhythmia can occur that subsequently subside over time.253,254,255,436 Whether this is due to an early “inflammatory” response in the atrium or pericardium remains hypothetical. Based on these observations, prior consensus statements, and the present consensus document, the writing group recommends the use of a 3-month blanking period immediately postablation, during which arrhythmia recurrences are not counted toward the primary recurrence endpoint (Table 10). The use of a blanking period is not without limitations. Although half of all early recurrences might subside, early recurrence remains a very significant predictor of late recurrence of AF.141,142,143,255 Furthermore, some studies have shown that recurrences occurring early in the blanking period (within 1–2 months) are less predictive of late recurrence, whereas those occurring in the third month have a very high predictive value for later recurrence.933,977,1389 Blanking periods can also be applied inconsistently, typically after the initial ablation, but not typically after repeat procedures, particularly when there is only a limited duration of follow-up. Despite these limitations, the writing group consensus continues to recommend the use of a 3-month blanking period for atrial arrhythmia recurrences post-initial ablation for AF. If alternate durations of blanking are employed, they should be prespecified in the trial methodology. Clinical trials should also consider routine discontinuation of AADs after the blanking period to determine off-drug success rates of ablation. Large clinical trials such as CABANA have also employed extensive ongoing monitoring, which could shed light on more robust blanking period definitions. The currently recommended definitions of the blanking periods, monitoring standards, complications, and other AF ablation clinical trial definitions are provided in Tables 8 and 10."}