Key result
Requiring a pacemaker after AF ablation in SND is linked to ~109% higher AF recurrence.
Why the study?
The study was conducted to evaluate the long-term clinical outcomes and incidence of permanent pacemaker implantation after catheter ablation in patients with AF and sinus node dysfunction.
What is the incidence and predictors of permanent pacemaker implantation after catheter ablation in patients with atrial fibrillation and sinus node dysfunction?
Cohort (n=222)
No
What is the incidence and predictors of permanent pacemaker implantation after catheter ablation in patients with atrial fibrillation and sinus node dysfunction?
Absolute Event Rate: 68% vs 32.5%
p-value: p=0.001
In patients with atrial fibrillation and underlying sinus node dysfunction undergoing catheter ablation, approximately 11% require permanent pacemaker implantation, often within 3 months, and this is associated with higher AF recurrence.
Alerts clinicians to monitor SND patients post-ablation; leaves open whether avoiding anterior lines reduces pacemaker need.
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.
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Hwang et al. (2020) conducted a cohort in Atrial fibrillation with sinus node dysfunction (n=222). Permanent pacemaker implantation after catheter ablation vs. No permanent pacemaker implantation was evaluated on Clinical atrial fibrillation recurrence (p=0.001). After catheter ablation for atrial fibrillation in patients with sinus node dysfunction, 11.3% required permanent pacemaker implantation, and these patients experienced a significantly higher rate of clinical AF recurrence (68.0% vs. 32.5%).
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