I’ve argued this “ideological” conflict of interest is much more problematic than the “perceived” financial conflicts that are routinely disclosed

When being a contrarian brings acclaim and financial reward you tend to move behaviour towards actions that reinforce the outcome

It’s like pop music

The shorter blanking will enable earlier intervention to improve clinical outcomes (eg, early reablation) at the expense of potentially overtreating a minority of patients (4%) with a low burden of AF.

www.ahajournals.org/doi/10.1161/...

Perhaps more interesting is the observation that failure timing and burden were interrelated.

Those who failed earlier (e.g. month 3) had nearly 20x higher burden than those that failed later (after month 3).

We found:
1. A shorter blanking period lowered the one-year freedom from atrial tachyarrhythmia to 49.6% (8 week blanking) from 53.7% (12 week blanking), but
2. The median AF burden in patients with arrhythmia recurrence did not differ between an 8- and 12-week blanking period (0.18% vs 0.23%).

We to investigate the clinical implications of a shortened blanking period on arrhythmia-free survival and AF burden in the CIRCA-DOSE cohort as this population had implantable monitors with all episodes following ablation being independently adjudicated.

www.ahajournals.org/doi/full/10....

Recently the 2024 EHRA/HRS/APHRS/LAHRS expert consensus statement on catheter and surgical ablation of atrial fibrillation shortened the blanking period from 12w to 8w.
academic.oup.com/europace/art...

Early arrhythmia recurrences following AF ablation are frequent and negatively impact patient outcomes.

As most early recurrences are transient, it is common to use a postprocedural blanking period, whereby recurrences don’t count as treatment failure.

onlinelibrary.wiley.com/doi/10.1111/...

I dislike the book, but rule 10.

“If you don't take a temperature, you can't find a fever”

Remarkably these trials show a very consistent result, catheter ablation was associated with a 85% reduction in the rate of progression to more advanced forms of AF (eg persistent AF).

Meaning we now have an intervention that is disease modifying.

www.heartrhythmjournal.com/article/S154...

But observational evidence doesn't tell us about treatment effects, so the issue remained unresolved until recently

In the past few years we have seen 5 RCTs compare pharmacotherapy to catheter ablation as a first, second, or third line therapy

www.nejm.org/doi/full/10....

But studies (and clinical management) tends to focus merely on the recurrence of arrhythmia, often not considering that our interventions can be disease modifying.

For example, observational evidence suggested progression was greatest in those treated with rate control…