Sick sinus syndrome in patients undergoing atrial fibrillation ablation was associated with more frequent PVI-plus ablation (OR 2.087) but similar 36-month AF recurrence (sHR 1.314, 95% CI 0.812-2.127).
Cohort (n=676)
Does the presence of sick sinus syndrome affect procedural complexity and long-term atrial fibrillation recurrence in patients undergoing initial radiofrequency ablation?
Patients with sick sinus syndrome undergoing atrial fibrillation ablation require more complex procedures for concomitant arrhythmias but achieve comparable long-term freedom from AF recurrence compared to patients without sick sinus syndrome.
Effect estimate: sHR 1.314 (95% CI 0.812-2.127)
Absolute Event Rate: 42% vs 31%
ABSTRACT Background The procedural complexity and outcomes of atrial fibrillation (AF) ablation in patients with sick sinus syndrome (SSS) remain unclear. This study aimed to evaluate procedural strategies, including pulmonary vein isolation (PVI) and additional ablation, and AF recurrence according to SSS status. Methods and Results This retrospective study included 53 patients with SSS and 623 without SSS undergoing initial radiofrequency AF ablation. PVI‐plus ablation was defined as any ablation targeting the cavotricuspid isthmus (CTI) for common atrial flutter (AFL), non‐pulmonary vein (non‐PV) foci, or atrial tachycardia. PVI‐plus ablation and AF recurrence were compared using 1:5 propensity score matching (53 with SSS and 265 without SSS). PVI‐plus was more frequent in the SSS group than in the non‐SSS group (47% vs. 29%, p = 0.005), particularly CTI ablation (38% vs. 21%, p = 0.005) and non‐PV foci ablation (15% vs. 7%, p = 0.026). SSS was associated with higher odds of PVI‐plus (odds ratio 2.087; 95% CI, 1.146–3.787). AF recurrence at 36 months did not differ significantly between SSS and non‐SSS (42% vs. 31%; sHR 1.314; 95% CI, 0.812–2.127). During follow‐up, new permanent pacemaker implantation was required in seven SSS patients (13%). Conclusion Patients with SSS more frequently underwent PVI‐plus ablation for AFL or non‐PV foci, yet long‐term AF recurrence was comparable to that in non‐SSS patients, underscoring the importance of careful assessment for concomitant atrial arrhythmias in this population.
Horie et al. (Sat,) conducted a cohort in Atrial fibrillation and sick sinus syndrome (n=676). Radiofrequency AF ablation in patients with SSS vs. Radiofrequency AF ablation in patients without SSS was evaluated on AF recurrence at 36 months (sHR 1.314, 95% CI 0.812-2.127). Sick sinus syndrome in patients undergoing atrial fibrillation ablation was associated with more frequent PVI-plus ablation (OR 2.087) but similar 36-month AF recurrence (sHR 1.314, 95% CI 0.812-2.127).