Key result
Peri-SVC ablation is linked to higher risk of acute sinus node dysfunction, a <0.5% complication.
Why the study?
What is the incidence and risk factors for acute sinus node dysfunction following atrial ablation for atrial fibrillation or flutter?
Cohort (n=2,151)
What is the incidence and risk factors for acute sinus node dysfunction following atrial ablation for atrial fibrillation or flutter?
Acute sinus node dysfunction is a rare (<0.5%) but significant complication of atrial ablation, particularly associated with peri-SVC ablation, often requiring permanent pacemaker implantation.
Peri-SVC ablation warrants heightened monitoring for acute sinus node dysfunction; leaves open causal confirmation in prospective studies.
BACKGROUND: Many patients with atrial fibrillation (AF) or atrial flutter (Aflutter) have concomitant sinus node dysfunction (SND). Ablation may result in injury to the sinus node complex or its blood supply resulting in sinus arrest and need for temporary pacing. We sought to characterize patients who develop acute SND (ASND) during/immediately after AF/Aflutter ablation. METHODS: We performed a retrospective analysis of AF/Aflutter ablation patients between January 1, 2010 and February 28, 2015 to characterize those who required temporary pacemaker (TPM) implantation due to ASND (sinus arrest, sinus bradycardia <40 beats/min, or junctional rhythm with hemodynamic compromise) following atrial ablation. RESULTS: Of 2,151 patients, eight patients (<0.5%) with ASND manifesting as sinus arrest (n = 2), severe sinus bradycardia (n = 2), and junctional rhythm with hemodynamic compromise (n = 4) were identified (all male, age 66 ± 9.9 years, 4/8 [50%] persistent AF). AF ablation was performed in four, atypical Aflutter in one, and AF/Aflutter in three patients. The ablation set consisted of: pulmonary vein (PV) isolation (n = 6), roof line ablation (n = 6), mitral annulus-left inferior PV line ablation (n = 5), left atrial appendage-mitral annulus ablation (n = 1), cavotricuspid isthmus ablation (n = 5), and isolation or ablation near the superior vena cava (SVC, n = 4). Patients with peri-SVC ablation were more likely to develop ASND (P = 0.03). All patients received TPM; six received permanent pacemaker before discharge, performed 3.5 days postablation (range 2-6 days). At 3-month device interrogation, all patients were atrially paced >50%. CONCLUSION: ASND is a rare complication of atrial ablation. It may be more common when peri-SVC ablation is performed and may necessitate permanent pacemaker implantation.
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Killu et al. (2016) conducted a cohort in Atrial fibrillation or atrial flutter (n=2,151). Atrial ablation was evaluated on Acute sinus node dysfunction (ASND) requiring temporary pacemaker implantation (p=0.03). Acute sinus node dysfunction is a rare complication (<0.5%) of atrial ablation that may necessitate permanent pacemaker implantation, and is more likely with peri-SVC ablation (P=0.03).
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