Key result
Persistent atrial flutter ablation is linked to acute sinus node dysfunction requiring temporary pacing in ~6%.
Why the study?
Identifying sinus node dysfunction before terminating persistent AFL by catheter ablation is challenging, motivating investigation into the characteristics and predictors of acute and delayed SND following ablation.
Cohort (n=221)
No
Following successful ablation of persistent atrial flutter, patients—especially those who are older or have a history of hypothyroidism—require close monitoring for at least one year due to the risk of delayed sinus node dysfunction requiring permanent pacing.
May warrant extended post-ablation monitoring for delayed SND; observational data leaves open optimal duration and risk stratification.
Identification of sinus node dysfunction (SND) before termination of persistent AFL by catheter ablation (CA) is challenging. This study aimed to investigate the characteristics and predictors of acute and delayed SND after AFL ablation. We retrospectively enrolled 221 patients undergoing CA of persistent AFL in a tertiary referral center. Patients with SND who required a temporary pacemaker (TPM) after termination of AFL or a permanent pacemaker (PPM) during follow-up were identified. Acute SND requiring a TPM was found in 14 of 221 (6.3%) patients following successful termination of AFL. A total of 10 of the 14 patients (71.4%) recovered from acute SND. An additional 11 (5%) patients presenting with delayed SND required a PPM during follow-up, including 4 patients recovering from acute SND. Of these, 9 of these 11 patients (81.8%) underwent PPM implantation within 1 year after the ablation. In multivariable analysis, female gender and a history of hypothyroidism were associated with the requirement for a TPM following termination of persistent AFL, while older age and a history of hypothyroidism predicted PPM implantation. This study concluded that the majority of patients with acute SND still require a PPM implantation despite the initial improvement. Therefore, it is reasonable to monitor the patients closely for at least one year after AFL ablation.
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Li et al. (2022) conducted a cohort in Persistent atrial flutter (n=221). Catheter ablation was evaluated on Acute sinus node dysfunction requiring a temporary pacemaker. Following catheter ablation of persistent atrial flutter, acute sinus node dysfunction requiring a temporary pacemaker occurred in 6.3% of patients, and 5% required a permanent pacemaker.
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