Key result
Prolonged AF termination pauses predict ~33% greater need for PPM implantation after catheter ablation.
Why the study?
What predicts the need for permanent pacemaker implantation after catheter ablation in patients with atrial fibrillation and tachycardia-bradycardia syndrome?
Cohort (n=121)
No
What predicts the need for permanent pacemaker implantation after catheter ablation in patients with atrial fibrillation and tachycardia-bradycardia syndrome?
In patients with atrial fibrillation and tachycardia-bradycardia syndrome, a sinus pause of ≥6.3 seconds upon AF termination strongly predicts the need for permanent pacemaker implantation despite catheter ablation.
Long sinus pauses on AF termination may identify pacemaker candidates after ablation; leaves open ablation's role in tachycardia-bradycardia syndrome.
There is a controversy as to whether catheter ablation should be the first-line therapy for tachycardia-bradycardia syndrome (TBS) in patients with atrial fibrillation (AF). We aimed to investigate long-term clinical outcomes of catheter ablation in patients with TBS and AF. Among 145 consecutive patients who underwent catheter ablation of AF with TBS, 121 patients were studied. Among 121 patients, 11 (9.1%) received implantation of a permanent pacemaker during a mean 21 months after ablation. Length of pause on termination of AF was significantly greater in patients who received pacemaker implantation after ablation than those who underwent ablation only (7.9 ± 3.5 vs. 5.1 ± 2.1 s, p < 0.001). Using a multivariate model, a long pause of 6.3 s or longer after termination of AF was associated with the requirement to implant a permanent pacemaker after ablation (HR 1.332, 95% CI 1.115-1.591, p = 0.002). This study suggests that, in patients with AF predisposing to TBS, long pause on termination of AF predicts the need to implant a permanent pacemaker after catheter ablation.
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Kim et al. (2018) conducted a cohort in Atrial fibrillation with tachycardia-bradycardia syndrome (n=121). Catheter ablation was evaluated on Freedom from atrial tachyarrhythmia(s) (AF or AT). A pause of 6.3 seconds or longer on termination of atrial fibrillation predicted the need for permanent pacemaker implantation after catheter ablation (HR 1.332).
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