Blanking Period Events Predict Long‐Term Recurrence After Substrate Modification Ablation for Atrial Fibrillation

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ABSTRACT Background The prognostic significance of blanking period arrhythmic events following extensive substrate modification ablation, such as the STABLE‐SR procedure, remains inadequately defined. Methods In this single‐center retrospective study, we analyzed data from 411 consecutive patients with non‐paroxysmal atrial fibrillation (AF) undergoing first‐time catheter ablation using the STABLE‐SR technique. The incidence and characteristics of blanking period events (within 3 months post‐ablation) were assessed. All patients were followed for 1 year to determine AF recurrence. Univariable and multivariable Logistic regression analyses were performed to identify predictors of recurrence. Results Among the 373 patients who completed follow‐up, blanking period events occurred in 106 patients (28.4%). The 1‐year recurrence rate was significantly higher in patients with blanking period events compared to those without (46.2% vs. 16.9%, p < 0.001). Multivariable analysis identified the presence of any blanking period event (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.22–6.11, p = 0.014), adjunctive cavotricuspid isthmus ablation (OR 1.91, 95% CI 1.01–3.36, p = 0.047), and the need for end‐procedural electrical cardioversion (OR 3.10, 95% CI 1.01–9.48, p = 0.047) as independent predictors of long‐term recurrence. Conclusions In patients undergoing STABLE‐SR ablation for non‐paroxysmal AF, arrhythmias during the blanking period are common and constitute the strongest independent predictor of 1‐year recurrence. Specific procedural characteristics further stratify recurrence risk.