Very-early detection of atrial fibrillation after ablation evaluated by a wearable ECG-patch predicts late blanking period recurrence: preliminary data from a prospective registry

IJC Hea & Vascula u e 51 (2024) 101369 A ailable online 21 Feb ua y 2024 2352-9067/© 2024 The Au ho s. Published by Else ie B.V. This is an open access a icle unde he CC BY-NC-ND license (h p://c ea i ecommons.o g/licenses/by- nc-nd/4.0/). Ve y-ea ly de ec ion o a ial ib illa ion a e abla ion e alua ed by a wea able ECG-pa ch p edic s la e blanking pe iod ecu ence: P elimina y da a om a p ospec i e egis y Miguel Ma ques An unes a , b , 1 , * , Ped o Sil a Cunha a , c , 1 , B´ a ba a Lace da Teixei a a , 1 , Guilhe me Po ugal a , c , B uno Valen e a , 1 , Ana Lousinha a , 1 , Ana So ia Delgado a , 1 , Sand a Al es a , 1 , C´ a ia Gue a a , 1 , Rui C uz Fe ei a a , 1 , M´ a io Ma ins Oli ei a a , c , 1 a Ca diology Depa men , Hospi al San a Ma a, Cen o Hospi ala Uni e si ´ a io de Lisboa Cen al, Cen o Clínico Acad´ emico de Lisboa (CCAL), Lisbon, Po ugal b Clinical Pha macology and The apeu ics Uni - Cen o Ca dio ascula Da Uni e sidade de Lisboa (CCUL@RISE), Faculdade de Medicina Da Uni e sidade de Lisboa c Faculdade de Medicina, CCUL, Uni e sidade de Lisboa, Lisbon, Po ugal ARTICLE INFO Keywo ds: A ial ib illa ion A y hmia Blanking pe iod Ex e nal loop eco de Recu ence Abla ion ABSTRACT In oduc ion: A ial ib illa ion (AF) abla ion ep esen s a sa e and e ec i e p ocedu e o es o e sinus hy hm. The idea ha pos -p ocedu al AF episodes - du ing he blanking pe iod - a e no conside ed ea men ailu e has been inc easingly challenged. The E-Pa ch, a single-use adhesi e elec ode, acili a es ex ended con inuous ECG moni o ing o 120 h. This pilo s udy aims o assess he e ec i eness o his ambula o y moni o ing de ice and in es iga e whe he e y-ea ly AF ecu ence co ela es wi h delayed blanking pe iod abla ion ou comes. Me hods: We conduc ed a single-cen e , p ospec i e, longi udinal s udy, including consecu i e pos -abla ion pa ien s moni o ed wi h he E-pa ch. The abili y o he de ice o con inuously eco d was analyzed, as well as he occu ence o AF episodes du ing ex e nal 7-day loop- eco de in he 2nd-mon h pos -abla ion. Resul s: We included 40 pa ien s, median age 62 yea s (IQR 56–70). E-Pa ch moni o ing was ob ained o a median o 118 h (IQR 112–120), wi h no discom o no in e p e a ion a e ac s. Ve y-ea ly AF ecu ence was de ec ed in 11 (27.5 %) pa ien s, wi h a median AF bu den o 7 % (IQR 6 %–33 %). La e-blanking pe iod AF was de ec ed in 13 (33 %) o he ex e nal 7-day loop eco dings. O he 11 pa ien s ha had e y-ea ly AF ecu ence, 10 (91 %) had la e-blanking AF. Ve y-ea ly AF de ec ion showed 77 % (95 % CI 64 %-90 %) sensi i i y and 96 % (95 % CI 90–100 %) speci ici y in p edic ing la e-blanking AF, wi h a non-pa ame ic ROC cu e AUC o 0.903 (95 % 0.797––1.0). Conclusion: The E-Pa ch was able o de ec e y-ea ly AF du ing an ex ended pe iod. Ve y-ea ly AF de ec ion eme ges as a p edic o o AF ecu ence du ing he la e blanking pe iod pos -abla ion. 1. In oduc ion A ial ib illa ion (AF) abla ion h ough pulmona y ein isola ion (PVI) is a sa e and e icacious p ocedu e o achie ing sinus hy hm in pa ien s wi h pa oxysmal o pe sis en AF [1]. An ea ly hy hm con ol s a egy has shown clinical bene i and is cu en ly he p e e ed pa hway o mos symp oma ic pa ien s wi h AF.[1,2] When choosing he s a egy o hy hm con ol, AF abla ion has been shown o pe o m be e han an ia hy hmics in imp o ing quali y o li e and educing symp oms and AF bu den.[3] Addi ionally, in he EARLY-AF ial, pa- ien s wi h pa oxysmal AF unde going c yoballoon abla ion we e shown o ha e a lowe a e o AF ecu ence and he apy- ela ed ad e se ou - comes.[4]. While being es ablished as an e icien and bene icial he apeu ic in e en ion, a signi ican p opo ion o pa ien s expe ience AF ecu - ence a e abla ion.[1,5] Risk ac o s associa ed wi h ecu ence include non-pa oxysmal AF, old age, le a ial (LA) size, and concomi- an como bidi ies - such as hea ailu e, hype ension, and obs uc i e * Co esponding au ho a : Hospi al San a Ma a - Ca diology Se ice - A hy hmology, Pacing, and Elec ophysiology Uni , R. de San a Ma a 50, 1169-024 Lisboa, Po ugal. E-mail add ess: [email p o ec ed] (M. Ma ques An unes). 1 This au ho akes esponsibili y o all aspec s o he eliabili y and eedom om bias o he da a p esen ed and hei discussed in e p e a ion. Con en s lis s a ailable a ScienceDi ec IJC Hea & Vascula u e jou nal homepage: www.sciencedi ec .com/jou nal/ijc-hea -and- ascula u e h ps://doi.o g/10.1016/j.ijcha.2024.101369 Recei ed 10 Decembe 2023; Recei ed in e ised o m 23 Janua y 2024; Accep ed 18 Feb ua y 2024 IJC Hea & Vascula u e 51 (2024) 101369 2 sleep apnea (OSA).[6] Di e en sco es ha e been de eloped o e alua e he isk o AF ecu ence, bu hey ha e gene ally unde pe o med.[6] O no e, a ele an p edic i e alue o ea ly AF ecu ence, has eme ged as a s ong indi idual p edic o o la e AF ecu ence [6–8]. Ea ly AF ecu ence is de ined as he occu ence o AF wi hin 3 mon hs ollowing abla ion. This pe iod o ea ly ecu ence – he blanking pe iod – was i s desc ibed 20 yea s ago when i was obse ed ha 15–49 % o pa ien s ha had a ecu ence in his pe iod ended up ha ing delayed cu e om AF on a longe ollow-up.[9–12] Concu en p o and an i-a hy hmic ac o s compe e in his ea ly pe iod.[12] Tissue ischemia and p oli e a ion, ansien local in lamma ion, cellula oxida i e s ess, ne e sp ou ing and issue nec osis due o ca he e abla ion con ibu e o AF ecu ence, whe eas pa asympa he ic dene - a ion, sca ma u a ion and mechanical s abiliza ion con ibu e as p o ec i e p ocesses.[12] These mul i ac o ial inpu s lead o a s ong p edic o o la e ecu ence ha is s ill a subjec o ac i e in es iga ion, namely ega ding he 3-mon h cu o du a ion and he a hy hmic bu den du ing he blanking pe iod, wi h newe e idence poin ing o a e y high isk o AF a 12 mon hs ollow-up o pa ien s wi h ea ly AF ecu ence[7,13]. While un il ecen ly we ha e been using adi ional ECG and Hol e moni o ing able o moni o AF ecu ence, new sma gadge s and wea able de ices a e now a ailable o hea hy hm moni o ing. Single- use adhesi e elec odes, such as he E-Pa ch (Bio Tel Hea ), allow o con inuous ECG moni o ing o up o 120 h. This new moni o ing mo- dali y makes i easie o ollow hea a e and hy hm on an ou pa ien basis in he immedia e pe iod a e PVI (Fig. 1). In his pilo s udy, we se ou o assess he abili y o his con inuous ambula o y moni o ing wea able de ice o de ec AF, and whe he e y- ea ly AF ecu ence co ela ed wi h la e-blanking abla ion ou comes. 2. Me hods 2.1. S udy design We pe o med a p ospec i e, single-cen e, longi udinal s udy ha included consecu i e pa ien s unde going i s AF abla ion. Pa ien s subjec ed o AF abla ion consis ed o adul s wi h symp oma ic pa ox- ysmal o pe sis en AF. Acco ding o a p e iously published p o ocol, PVI was pe o med using adio equency o c yoabla ion echniques. [12] The ea ly moni o ing app oach consis ed o applying he ePa ch on he pa ien ’s ches du ing he i s 24 h a e PVI, a he momen o discha ge, wi h a con inuous eco ding o 5 days - a maximum o 120 h (Fig. 1). Subsequen ly, he occu ence o AF episodes was e alua ed using an ex e nal 7-day loop eco de placed in he 2nd-mon h pos - abla ion ( he la e blanking pe iod). In bo h de ices hea a e and R-R a iabili y plo s we e eco ded and checked by he au oma ed so wa e algo i hm. These acings we e hen e iewed by one echnician and alida ed by a ca diology specialis in elec ophysiology. An ia - hy hmic d ugs we e con inued h oughou he blanking pe iod wi h he same dosages as p io o abla ion. AF ecu ence was de ined i a pe iod o AF wi h >30 s was de ec ed in he ambula o y moni o ing, e alua ed a a 3-mon h ollow-up appoin men .[1] The p ima y ou come o he s udy was he co ela ion be ween AF de ec ion in he e y-ea ly ( ia he ePa ch wea able) and he la e blanking pe iod, e alua ed h ough he sensi i i y, speci ici y and p e- dic i e a ios o e y-ea ly blanking AF de ec ion as a p edic o o la e- blanking AF ecu ence. Seconda y ou comes included he e alua ion o po en ial p edic o s o la e AF ecu ence ob ained om ePa ch da a du ing he e y-ea ly blanking pe iod, namely he assessmen o s a is- ical pa ame e s o hea a e a iabili y (HRV) – SDNN (NN s anda d de ia ion o all eco ding), SDANN (NN s anda d de ia ion in all 5-min- u e segmen s o he eco ding), RMSSD (squa e oo o mean o sum o squa es o di e ences be ween adjacen NN in e als) and pNN50 (pe cen age o di e ences be ween adjacen no mal RR in e als ha a e g ea e han 50 ms compu ed om he en i e eco ding). The ePa ch ole abili y and e ec i eness in moni o ing hea hy hm o he s ipu- la ed ime ame we e also e alua ed. 2.2. S a is ical analysis Rele an da a ega ding popula ional cha ac e is ics, co-mo bidi ies and pha maco he apy was collec ed be o e PVI. Con inuous a iables we e epo ed as mean ±SD o median o IQR, depending on he da a dis ibu ion pa e n. Ca ego ical da a we e depic ed as equencies and pe cen ages. Di e ences be ween g oups we e calcula ed using Fishe ’s exac es and he Wilcoxon ank-sum o ca ego ical and con inuous da a, espec i ely. E alua ion o p edic o s o la e-blanking AF ecu - ence was pe o med using uni a ia e logis ic eg ession models o assess o in e ac ions be ween dependen and independen a iables. Resea che s op ed no o pu sue mul i a ia e analysis gi en he low sample size and o e all e en a e.[14,15] Sensi i i y was de i ed h ough he a io o e y-ea ly ecu ence and all la e-blanking pe iod ecu ences. Speci ici y was calcula ed by di iding he numbe o no e y-ea ly ecu ences by he numbe o no ecu ences. Posi i e and nega i e p edic i e alues (PPV/NPV) we e de i ed om ou coho ’s es ima es o sensi i i y, speci ici y and disease p e alence. A ecei e ope a o cha ac e is ic (ROC) cu e analysis was pe o med o assess he co ela ion be ween he iming o e y-ea ly and la e blanking pe iod ecu ences, wi h he calcula ion o he a ea unde he cu e (AUC) assuming a non-pa ame ic model. Da a we e analyzed Fig. 1. The E-pa ch; A – The E-pa ch de ice; B – Applica ion o he E-pa ch emo e moni o ing de ice on he ches wall o a pa ien . M. Ma ques An unes e al. IJC Hea & Vascula u e 51 (2024) 101369 3 using S a a® S a is ical So wa e Package, Ve sion 17.0 (S a aCo p LP, College S a ion, Texas, EUA). 2.3. E hical conside a ions The hospi al e hics commi ee app o ed he s udy p o ocol (E hics Commi ee app o al numbe 974/2020). All pa icipan s p o ided w i en in o med consen o da a collec ion, and he s udy was con- duc ed acco ding o he Decla a ion o Helsinki guidelines. 3. Resul s A o al o 48 pa ien s we e sc eened o en y in his p ospec i e s udy, wi h a o al o 8 pa ien s no accep ing ea ly moni o ing wi h he E-pa ch. Ou pa ien coho consis ed o a o al o 40 sequen ial pa ien s ha we e included om No embe 2021 o Ma ch 2022. The median pa ien age was 62 (IQR 56–70), wi h 16 (40 %) emales, p esen ing wi h pa oxysmal AF (n =25, 62.5 %) and pe sis en AF (n =15, 37.5 %). C yoabla ion was used in 17 cases (42.5 %) and adio equency in he emaining pa icipan s. PVI was success ul in all he pa ien s, wi hou pe ip ocedu al complica ions. The e we e no s a is ically signi ican di e ences in he use o an ia hy hmic d ugs be ween pa ien g oups. Gene al coho cha ac e is ics a e p esen ed in Table 1. Rhy hm moni o ing wi h he ePa ch was ob ained o a median o 118 (IQR 112–120) hou s, wi h a minimum e ec i e moni o ing du a- ion o 50 h. No discom o complain s in he use o he de ice no he appea ance o in e p e a ion a e ac s we e egis e ed (Supplemen a y Fig. 1). Ve y-ea ly AF ecu ence was de ec ed in 11 (27.5 %) pa ien s, wi h a median AF bu den o 7 % (IQR 6 %–33 %). La e blanking pe iod AF was de ec ed in 13 (33 %) o he ex e nal 7-day loop eco dings. Ou o he 11 pa ien s ha had e y-ea ly AF ecu ence de ec ed in he ePa ch moni o ing, 10 (91 %) main ained la e-blanking pe iods o AF. Ve y-ea ly AF de ec ion showed a sensi i i y o 77 % (95 % CI 64 %-90 %) and a speci ici y o 96 % (95 % CI 90–100 %) in p edic ing la e- blanking AF, wi h a PPV o 91 % (95 % CI 82 %-100 %) and a NPV o 90 % (95 % CI 80 %-100 %). A non-pa ame ic ROC cu e analysis de i ed an AUC o 0.903 (95 % 0.797––1.0) (Fig. 2). Addi ionally, a non- s a is ically signi ican end o highe HRV pa ame e s du ing he ePa ch moni o ing was obse ed in pa ien s p esen ing wi h AF ecu - ence du ing he la e blanking pe iod, wi h he pNN50 a iable (a ma ke e lec ing he agal one) showing a signi ican alue in he uni a ia e logis ic eg ession analysis (Table 2 and Supplemen a y Table 2). 4. Discussion Ou wo k ocused on he cha ac e iza ion o he e y-ea ly pe iod ollowing PVI h ough con inuous ambula o y eco ding using a ake- home wea able ECG-pa ch. In his pilo s udy, he ePa ch was well ole a ed among all pa ien s and was able o de ec e y-ea ly AF, which was highly p edic i e o la e-blanking AF ecu ence. While his inding should be in e p e ed in he con ex o an unblinded s udy wi h a small sample size, ou esul s emphasize he impo ance o he occu ence o AF du ing he blanking in p edic ing la e AF e en s.[6,7,13] The new da a is he ac ha e y-ea ly iden i ica ion o AF a e PVI has a high p edic i e powe o la e-blanking pe iod AF ecu ence. As p e iously men ioned, he e is cu en ly an open deba e ega ding he du a ion o he blanking pe iod and i s ele ance o pa ien s and clinical ou comes.[7,13] The median 7 % bu den o AF du ing he e y- Table 1 Gene al pa ien cha ac e is ics s a i ied by la e-blanking ecu ence s a us. Cha ac e is ics To al pa ien s (N =40) Wi h la e blanking AF ecu ence (N =27) Wi hou la e blanking AF ecu ence (N =13) p- alue Age - y [IQR] 62 [70- 56] 59[70-57] 66 [70-55] 0.177 Female sex - n (%) 16 (40 %) 10 (37 %) 6 (46 %) 0.581 C yoabla ion – n (%) 17 (42.5 %) 13 (48 %) 4 (30 %) 0.298 BMI [IQR] 28[32- 24] 28[31-24] 29[33-25] 0.678 Pa oxysmal AF - n (%) 25 (62.5 %) 15 (55 %) 10 (77 %) 0.191 Pe sis en AF - n (%) 15 (37.5 %) 14 (52 %) 1 (8 %) 0.191 Hype ension - n (%) 22 (55 %) 15 (55 %) 7 (54 %) 0.919 Hype choles e olemia - n (%) 18 (45 %) 14 (52 %) 4 (31 %) 0.207 Diabe es - n (%) 3 (7.5 %) 1 (4 %) 2 (16 %) 0.189 OSA - n (%) 4 (10 %) 2 (8 %) 2 (26 %) 0.431 Smoke - n (%) 6 (15 %) 5 (19 %) 1 (8 %) 0.369 CKD - n (%) 4 (10 %) 1 (4 %) 3 (23 %) 0.056 Thy oid disease - n (%) 9 (22.5 %) 6 (22 %) 3 (23 %) 0.952 Cance - n (%) 4 (10 %) 1 (4 %) 3 (23 %) 0.056 Hea Failu e - n (%) 9 (22.5 %) 6 (22 %) 3 (23 %) 0.952 Co ona y disease - n (%) 2 (5 %) 1 (4 %) 1 (8 %) 0.588 Ischemic s oke - (%) 2 (5 %) 1 (4 %) 1 (8 %) 0.588 CHA2DS2-VASc [IQR] 2[3-1] 2[3-2] 2[2-1] 0.216 To al medica ion [IQR] 4 [5-3] 4[5-3] 4[6-3] 0.923 Be a-Blocke s – n (%) 32 (80 %) 23 (85 %) 9 (69 %) 0.237 Class I an ya y hmics – n (%) 11 (27.5 %) 9 (33 %) 2 (16 %) 0.234 Class III an ya y hmics – n (%) 5 (12.5 %) 4 (15 %) 1 (8 %) 0.523 Vi amin K an agonis – n (%) 3 (7.5 %) 2 (8 %) 1 (8 %) 0.432 DOAC – n (%) 37 (93 %) 27 (93 %) 10 (91 %) 0.888 ACE-Inhibi o – n (%) 20 (50 %) 15 (55 %) 5 (38 %) 0.311 MRA – n (%) 5 (12.5 %) 4 (15 %) 1 (8 %) 0.505 AF – A ial ib illa ion AF; N – numbe ; y – yea s; SD – s anda d de ia ion; BMI – body mass index, OSA – obs uc i e sleep apnea; CKD – ch onic kidney disease; DOAC – di ec o al an icoagulan ; ACE – angio ensin-con e ing enzyme; mine aloco icoid ecep o an agonis . Fig. 2. Non-pa ame ic ROC cu e o he p edic i e e ec o e y-ea ly blanking a ial ib illa ion ecu ence in p edic ing la e blanking a ial ib il- la ion ecu ence wi h a calcula ed AUC o 0.903. M. Ma ques An unes e al. IJC Hea & Vascula u e 51 (2024) 101369 4 ea ly blanking pe iod obse ed in his s udy co esponds o app oxi- ma ely 100 min o median daily AF, which ep esen s a signi ican bu den, i e imes highe han he 23-minu e daily cu o poin , ha ep esen ed a se en- old inc ease in he isk o AF a one-yea ollow-up obse ed on a p io s udy om ou g oup’[7]. The ac ha mos pa ien s showing e y-ea ly AF ecu ence had i wi h a signi ican a hy hmia bu den may be in e p e ed as an indica o ha an AF bu den cu o can be used in he u u e as a p edic o o AF ecu ence and clinical ou - comes - bu u he s udies a e needed o alida e hese esul s. La e de ec ion o AF ecu ence du ing he blanking pe iod has been highly co ela ed wi h AF ecu ence.[13,14] A sub-analysis o he DECAAF-II ial has indica ed ha a highe bu den o AF de ec ion du ing he la e-blanking pe iod h ough an in e mi en eco ding wi h a sma phone co ela ed wi h AF ecu ence a 90 days.[14] Addi ionally, a sub-analysis o he ADVICE ial has showed ha a 1-yea ollow up, compa ing o 23 % wi hou symp oma ic AF du ing he blanking pe iod, 92 % o pa ien s ha had symp oma ic AF du ing he la e blanking pe iod had 1-yea ecu ence.[13] In bo h sub-analyses he de ec ion o AF du ing he ea ly blanking pe iod also co ela ed – wi h less s eng h - wi h pos -blanking AF ecu ence. The ac ha he e y ea ly blanking pe iod was eco ded con inuously in ou pilo s udy may explain he high a e o concomi an de ec ion and conco dance be ween e y-ea ly and la e blanking pe iods. This e y-ea ly con inuous cha ac e iza ion may lead o a be e isk s a i ica ion o AF ecu ence in he u u e. Ea ly s udies on he blanking pe iod we e conduc ed in an e a in which AF abla ion echnology h ough adio equency PVI and idi- mensional mapping sys ems we e less de eloped. In ac , a highe deg ee o subs a e changes and in lamma ion caused by adio equency ene gy migh ha e been p oduced, yielding a highe a e o ea ly ecu ences ha we e no sus ained in ime when compa ed o cu en indings. [12,13] Albei no being powe ed o his pu pose, ou s udy ound no signal o a p o ec i e e ec o c yoabla ion compa ed o adio equency in ei he ea ly o la e AF ecu ence. Sympa he ic ne ous sys em (SNS), pa icula ly he pa asympa he ic ac i i y modula ion, has been conside ed as pa o he pos ula ed bene i s o an al PVI – wi h he achie emen o pa asympa he ic dene a ion in addi ion o PVI being sugges ed as a concu en an ia - hy hmic mechanism, inc easing he success o AF abla ion. [12,15] The indi ec assessmen o luc ua ions in SNS inpu s o he hea h ough s a is ical measu es o HRV has been hea ily linked o clinical ou comes, wi h highe alues o SDNN, RMSSD, and pNN50 being all signi ican ly associa ed wi h an inc eased isk o AF.[16–18] In ou s udy, highe HRV pa ame e s, ep esen ing excessi e au o- nomic luc ua ions, appea ed o be linked wi h AF ecu ence a e PVI. Howe e , hese indings ep esen a me e indica o o u u e s udies. 4.1. S udy limi a ions The mos impo an limi a ions o ou s udy a e connec ed o i s unblinded na u e, and he ac ha i was a single-cen e obse a ional s udy, albei p ospec i e. The s udy coho consis ed exclusi ely o pa- ien s unde going PVI abla ion, and submi ed bo h o an ea ly ePa ch e alua ion and la e blanking pe iod ex e nal loop eco ding. The e o e, i included a small selec ed popula ion. Also, HRV pa ame e s de i ed om he ePa ch wea able de ice da a migh no be as alida ed as in he s anda d 24 h Hol e eco ding. Howe e , ecen ly s udies used he ePa ch o success ully moni o HRV in di e en clinical se ings.[19,20] 5. Conclusions The E-Pa ch was able o de ec e y-ea ly AF du ing an ex ended pe iod o ime. The occu ence o AF in he e y-ea ly moni o ing ap- pea s o be signi ican ly p edic i e o la e blanking pe iod AF ecu ence pos -abla ion. Also, highe HRV alues, e lec ing excessi e au onomic luc ua ions, may be linked o an inc eased isk o la e blanking AF episodes. Ou p elimina y indings need o be alida ed in la ge co- ho s, p e e ably blinding o he ea ly eco ding esul s. G an suppo . This wo k did no ecei e any g an s. E hical disclosu es. P o ec ion o human and animal subjec s. The au ho s decla e ha no expe imen s we e pe o med on humans o animals o his s udy. Con iden iali y o da a. The au ho s decla e ha hey ha e ollowed he p o ocols o hei wo k cen e on he publica ion o pa ien da a. Righ o p i acy and in o med consen . The au ho s decla e ha no pa ien da a appea in his a icle. CRediT au ho ship con ibu ion s a emen Miguel Ma ques An unes: W i ing – e iew & edi ing, W i ing – o iginal d a , Visualiza ion, Valida ion, Supe ision, So wa e, Re- sou ces, P ojec adminis a ion, Me hodology, In es iga ion, Fo mal analysis, Da a cu a ion, Concep ualiza ion. Ped o Sil a Cunha: W i ing – e iew & edi ing, W i ing – o iginal d a , Valida ion, Supe ision, Resou ces, P ojec adminis a ion, Me hodology, In es iga ion, Fo mal analysis, Da a cu a ion, Concep ualiza ion. B´ a ba a Lace da Teixei a: W i ing – o iginal d a , Valida ion, So wa e, Da a cu a ion. Guilhe me Po ugal: W i ing – e iew & edi ing, In es iga ion, Fo mal analysis, Da a cu a ion, Concep ualiza ion. B uno Valen e: W i ing – o iginal d a , Valida ion, P ojec adminis a ion, Fo mal analysis, Concep uali- za ion. Ana Lousinha: W i ing – e iew & edi ing, P ojec adminis a- ion, In es iga ion, Fo mal analysis, Da a cu a ion. Ana So ia Delgado: . Sand a Al es: Valida ion, P ojec adminis a ion, Me hodology, In es iga ion, Fo mal analysis, Da a cu a ion. C´ a ia Gue a: Valida ion, So wa e, Resou ces, P ojec adminis a ion, Fo mal analysis, Da a cu a ion. Rui C uz Fe ei a: W i ing – e iew & edi ing, Visualiza ion, Table 2 Epa ch moni o ing da a s a i ied by la e-blanking ecu ence o a ial ib illa ion. Cha ac e is ics To al pa ien s (N =40) wi h la e blanking AF ecu ence (N = 27) wi hou la e blanking AF ecu ence (N = 13) p- alue Moni o ing ime - hou s [IQR] 118[120- 113] 118[120-112] 117[120-113] 0.912 A e age HR - [IQR] 66[72-60] 65[71-58] 70[75-60] 0.219 Maximum HR - [IQR] 113[123- 101] 112[132-100] 116[170-108] 0.318 Minimum HR - [IQR] 49[55-38] 49[55-42] 49[53-34] 0.410 SVE – n [IQR] 1544 [5666- 181] 1289[6089- 132] 3480[52431403] 0.114 Isola ed SVE – n [IQR] 1390 [5273] 1089[6089- 132] 2535[5199- 1397] 0.144 NN a e age - ms [IQR] 917[975- 838] 922[1036-875] 870[967-750] 0.143 SDNN - ms [IQR] 121[165- 97] 121[142-98] 160[228-85] 0.405 SDANN – ms [IQR] 101[120- 82] 101[110-85] 102[166-74] 0.670 RMSSD – ms [IQR] 47[76-37] 48[57-39] 45[94-26] 0.810 pNN >50 % - [IQR] 8 %[21-4] 7 % [12 %-4%] 15 % [44 %-4%] 0.285 AF – A ial ib illa ion AF; HR – hea a e; N – numbe ; y – yea s; SD – s anda d de ia ion; SVE – Sup a en icula Ec opy; NN - no mal o no mal in e al; SDNN – NN s anda d de ia ion in all eco ding; SDANN – NN s anda d de ia ion in all 5-minu e segmen s o he eco ding; RMSDD - Squa e oo o mean o sum o squa es o di e ences be ween adjacen NN in e als; pNN50 - Pe cen o di - e ences be ween adjacen no mal RR in e als ha a e g ea e han 50 ms compu ed o e he en i e eco ding. M. Ma ques An unes e al. IJC Hea & Vascula u e 51 (2024) 101369 5 Valida ion, Supe ision, Resou ces, Me hodology, Concep ualiza ion. M´ a io Ma ins Oli ei a: W i ing – e iew & edi ing, W i ing – o iginal d a , Visualiza ion, Valida ion, Supe ision, Resou ces, Me hodology, In es iga ion, Fo mal analysis, Concep ualiza ion. Decla a ion o compe ing in e es The au ho s decla e ha hey ha e no known compe ing inancial in e es s o pe sonal ela ionships ha could ha e appea ed o in luence he wo k epo ed in his pape . Acknowledgemen s None o decla e. Appendix A. Supplemen a y da a Supplemen a y da a o his a icle can be ound online a h ps://doi. o g/10.1016/j.ijcha.2024.101369. Re e ences [1] G. Hind icks, T. Po pa a, N. 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