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April 13, 2026Journal of Cardiovascular Electrophysiology

Procedural Complexity and Outcomes of Catheter Ablation for Atrial Fibrillation in Patients With Sick Sinus Syndrome

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Key result

Sick sinus syndrome linked to ~109% more frequent PVI-plus ablation but similar AF recurrence.

  • sHR 1.314
  • 95% CI 0.812-2.127
  • n=676

Why the study?

Procedural complexity and outcomes of AF ablation in patients with sick sinus syndrome remain unclear.

Does the presence of sick sinus syndrome affect procedural complexity and long-term atrial fibrillation recurrence in patients undergoing initial radiofrequency ablation?

Population

53 patients with SSS and 623 without SSS undergoing initial radiofrequency AF ablation

Comparison

Patients with SSS vs without SSS

Design

Retrospective propensity score-matched study

Follow-up

36 months

Authors

RHRikako HorieHKHiroshi KawakamiKKK. Kurokawa

Discussion

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Member takes

Overview

Expect increased procedural complexity in AF ablation for SSS without higher recurrence; extends observational data on comparable long-term efficacy.

Key Points

  • The study evaluates outcomes of AF ablation in patients with sick sinus syndrome compared to those without SSS.
  • Conducted a retrospective review of 676 patients who underwent initial radiofrequency AF ablation.
  • Compared PVI- plus ablation strategies between patients with SSS and those without SSS using propensity score matching.
  • Examined rates of AF recurrence and the need for permanent pacemaker implantation.
  • PVI-plus ablation was significantly more common in SSS patients (47%) compared to non-SSS patients (29%).
  • Higher odds of receiving PVI-plus ablation were found for patients with SSS (odds ratio 2.087).
  • AF recurrence at 36 months was similar between SSS and non-SSS patients (42% vs. 31%).

Study Design

Type

Cohort (n=676)

Structured PICO

Does the presence of sick sinus syndrome affect procedural complexity and long-term atrial fibrillation recurrence in patients undergoing initial radiofrequency ablation?

P
Population
676 patients undergoing initial radiofrequency catheter ablation for atrial fibrillation, including 53 with sick sinus syndrome (SSS) and 623 without SSS. A 1:5 propensity score-matched cohort included 53 SSS and 265 non-SSS patients.
I
Intervention
Initial radiofrequency catheter ablation for atrial fibrillation in patients with sick sinus syndrome (SSS)
C
Comparator
Initial radiofrequency catheter ablation for atrial fibrillation in patients without sick sinus syndrome (non-SSS)
O
Outcome
Procedural complexity (frequency of PVI-plus ablation, defined as ablation targeting the cavotricuspid isthmus, non-pulmonary vein foci, or atrial tachycardia) and atrial fibrillation recurrence at 36 monthshard clinical

Main Result

Effect estimate: sHR 1.314 (95% CI 0.812-2.127)

Absolute Event Rate: 42% vs 31%

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.

Cite This Study

Horie et al. (2026) 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).

synapsesocial.com/papers/69dc892e3afacbeac03eaf3dhttps://doi.org/10.1111/jce.70338
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Impact of Catheter Ablation for Paroxysmal Atrial Fibrillation in Patients With Sick Sinus Syndrome　– Important Role of Non-Pulmonary Vein Foci –2016 · 24 citations
  2. 2Presence of non-pulmonary vein foci in patients with atrial fibrillation undergoing standard ablation of pulmonary vein isolation: Clinical characteristics and long-term ablation outcome2021 · 37 citations
  3. 3Impact of Pre-Existing Bradycardia on Subsequent Need for Pacemaker Implantation After Radiofrequency Catheter Ablation for Atrial Fibrillation2018 · 7 citations
  4. 4High‐Density Mapping of the Sinus Node in Humans: Role of Preferential Pathways and the Effect of Remodeling2009 · 43 citations
  5. 5Sex Differences in the Regional Analysis of Nonpulmonary Vein Foci and Epicardial Adipose Tissue in Patients With Atrial Fibrillation2022 · 4 citations