Optimal blanking period following atrial fibrillation catheter ablation: a systematic review and diagnostic meta-analysis of over 28,000 patients

Studies have reported that early recurrences of atrial tachyarrhythmia (ERAT) following catheter ablation are significantly associated with late recurrence of atrial tachyarrhythmia (LRAT) and ablation failure. In this systematic review and diagnostic meta-analysis, we aimed to find the Optimum blanking period that properly differentiates permanent serious ERATs, which lead to LRAT or ablation failure, from the transient self-resolved ERATs.

Web of Science, Scopus, PubMed, and Embase were systematically searched for articles evaluating the optimal blanking period up to 31 March 2025. Two independent reviewers performed the screening, selection, and data extraction processes of studies that evaluated the association of ERAT and LRAT. Diagnostic meta-analysis was performed to find the optimum duration for the blanking period. Sub-group analysis according to the ablation source and sensitivity analysis on studies with low risk of bias were performed.

A Total of 33 studies, including 28,492 patients, were included. The pooled prevalence of LRAT in patients who experienced ERAT was 0.67 overall, 0.62, 0.73, and 0.75 in studies using radiofrequency ablation, cryoballoon ablation, and pulsed field ablation, respectively. Optimum cut-off for the blanking period was 31.04 days with sensitivity, specificity, and AUC-SROC of 0.51 (95 % CI 0.39 - 0.63), 0.73 (95 % CI 0.60 - 0.83), and 0.66 (95 % CI 0.56 - 0.75), respectively. The positive predictive value and negative predictive value for the optimum cut-off were 0.79 and 0.42.

ERAT occurring after 1 month following CA is strongly associated with LRAT or ablation failure. Shortening of the blanking period should be incorporated into future guidelines.Figure 1Figure 2