A case of transient tachy-bradycardia syndrome following combined atrial fibrillation ablation and left atrial appendage closure

Yijing Tao; Q. Zhang; Hongwu Chen; Qianwen Yao

doi:10.1186/s12872-026-05841-6

April 10, 2026BMC Cardiovascular DisordersOpen Access

A case of transient tachy-bradycardia syndrome following combined atrial fibrillation ablation and left atrial appendage closure

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Key Points

To describe a case of transient tachy-bradycardia syndrome characterized by rapid atrial fibrillation and sinus arrest after combined catheter ablation and left atrial appendage closure.
Clinical evaluation and management of a single patient with paroxysmal atrial fibrillation/flutter at high thromboembolic risk receiving combined pulmonary vein isolation (PVI) and left atrial appendage closure (LAAC).
Rhythm assessment conducted using perioperative continuous telemetry and 24-hour Holter electrocardiogram monitoring over a 3-month follow-up period.
Paroxysmal rapid atrial fibrillation accompanied by sinus arrest and prolonged pauses emerged following the combined ablation and device closure procedure.
Both tachyarrhythmias and sinus node dysfunction resolved gradually over 3 months without the need for temporary or permanent pacemaker implantation.

Structured PICO

P

Population

1 patient with paroxysmal atrial fibrillation/atrial flutter (AF/AFL) at high thromboembolic risk

I

Intervention

Combined pulmonary vein isolation (PVI) and left atrial appendage closure (LAAC)

O

Outcome

Development and resolution of transient tachy-bradycardia syndrome (paroxysmal rapid AF with sinus arrest)safety

Transient tachy-bradycardia syndrome following combined PVI and LAAC may resolve spontaneously, suggesting a watchful waiting strategy may be appropriate to avoid unnecessary pacemaker implantation.

Implication

May warrant watchful waiting over pacemaker implantation; leaves open generalizability after combined PVI and LAAC.

Abstract

Atrial fibrillation (AF) and atrial flutter (AFL) are common arrhythmias, with incidence increasing with age. Catheter ablation and left atrial appendage closure (LAAC) are guideline-recommended treatments for patient with AF and high thromboembolic risk of stroke. We report the case of a patient with paroxysmal AF/AFL at high thromboembolic risk who developed paroxysmal rapid AF with sinus arrest following combined pulmonary vein isolation (PVI) and LAAC. Notably, both the arrhythmia and sinus node dysfunction gradually resolved over three months without pacemaker implantation. We propose that a watchful waiting strategy may be appropriate in similar clinical scenarios.