Korean Circ J.  2020 Apr;50(4):346-357. 10.4070/kcj.2019.0268.

Permanent Pacemaker Implantations after Catheter Ablation in Patients with Atrial Fibrillation Associated with Underlying Sinus Node Dysfunction

• Hwang TH
• Yu HT
• Kim TH
• Uhm JS
• Kim JY
• Joung B
• Lee MH
• Pak HN

• KMID: 2471285
• DOI: http://doi.org/10.4070/kcj.2019.0268

Abstract

BACKGROUND AND OBJECTIVES
The objective of this study was to evaluate the long-term clinical outcomes and the incidence of permanent pacemaker implantation after catheter ablation in patients with of atrial fibrillation (AF) and sinus node dysfunction (SND).
METHODS
Among 3,068 total consecutive patients who underwent AF catheter ablation (AFCA), this study included 222 (9.5%; men 53.2%, 63.7±9.2 years of age, 81.5% paroxysmal AF) with underlying SND and a regular rhythm follow-up. We analyzed the rhythm outcomes, changes in the mean heart rate or heart rate variability, and permanent pacemaker implantation rate.
RESULTS
During 47.5±28.8 months of follow-up, 25 (11.3%) patients received pacemaker implantations due to symptomatic SND. More than half (56.0%, 14/25) underwent a pacemaker implantation within 3 months of the AFCA, and the annual pacemaker implantation rate was 2.0% afterwards. Both the early (68.0% vs. 31.0%, p<0.001) and clinical AF recurrence (68.0% vs. 32.5%, p=0.001) rates and continuous antiarrhythmic drug use after 3 months (44.0% vs. 24.4%, p=0.036) were significantly higher in patients requiring pacemaker implantations than those that did not. An anterior linear ablation (odds ratio [OR], 9.37 [3.03-28.9]; p<0.001) and the E/Em (OR, 1.15 [1.02-1.28]; p=0.018) were independently associated with permanent pacemaker implantations after AFCA in patients with AF and SND.
CONCLUSIONS
After AFCA in patients with AF and SND, 1 of 9 patients needed a pacemaker implantation and half needed implantations within 3 months. The AF recurrence rate was significantly higher in those who required pacemaker implantations after the AFCA.

Keyword

Sinus node dysfunction; Atrial fibrillation; Catheter ablation; Pacemaker, artificial

MeSH Terms

Atrial Fibrillation*
Catheter Ablation*
Catheters*
Follow-Up Studies
Heart Rate
Humans
Incidence
Male
Pacemaker, Artificial
Recurrence
Sick Sinus Syndrome*
Sinoatrial Node*

Figure

• 

  Figure 1 Flowchart of the patient analyses.AFCA = atrial fibrillation catheter ablation; F/U = follow-up; PM = pacemaker; RFCA = radiofrequency catheter ablation; SND = sinus node dysfunction; SSS = sick sinus syndrome; TBS = tachycardia-bradycardia syndrome.

• 

  Figure 2 Pacemaker implantation timing after the catheter ablation procedure.AFCA = atrial fibrillation catheter ablation.

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  Figure 3 Kaplan-Meier analysis with a log-rank test for the AF recurrence after the AFCA. (A) Patients with SND vs. without SND. (B) Patients who required a pacemaker implantation versus no pacemaker implantation. (C) AAD-free recurrence rates in the pacemaker group versus no pacemaker group. (D) AF recurrence under AADs in the pacemaker group versus no pacemaker group.AAD = anti-arrhythmic drug; AF = atrial fibrillation; AFCA = atrial fibrillation catheter ablation; SND = sinus node dysfunction; PM = pacemaker.

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