Catheter ablation eliminated both atrial fibrillation and prolonged sinus pauses in 86% of patients with tachycardia-bradycardia syndrome over a 5.8-year follow-up, with only 8% requiring a pacemaker.
Cohort (n=37)
Does catheter ablation eliminate tachyarrhythmia and bradycardia in patients with paroxysmal atrial fibrillation and prolonged sinus pauses?
Catheter ablation can successfully eliminate both AF and prolonged sinus pauses in the majority of patients with tachycardia-bradycardia syndrome, potentially avoiding the need for permanent pacemaker implantation.
AIMS: Although patients with paroxysmal atrial fibrillation (AF) and prolonged sinus pauses tachycardia-bradycardia syndrome (TBS) are generally treated by permanent pacemaker, catheter ablation has been reported to be a curative therapy for TBS without pacemaker implantation. The purpose of this study was to define the potential role of successful ablation in patients with TBS. METHODS AND RESULTS: Of 280 paroxysmal AF patients undergoing ablation, 37 TBS patients with both AF and symptomatic sinus pauses (age: 62 ± 8 years; mean maximum pauses: 6 ± 2 s) were analysed. During the 5.8 ± 1.2 years (range: 5-8.7 years) follow-up, both tachyarrhythmia and bradycardia were eliminated by a single procedure in 19 of 37 (51%) patients. Repeat procedures were performed in 14 of 18 patients with tachyarrhythmia recurrence (second: 12 and third: 2 patients). During the repeat procedure, 79% (45 of 57) of previously isolated pulmonary veins (PVs) were reconnected to the left atrium. Pulmonary vein tachycardia initiating the AF was found in 46% (17 of 37) and 43% (6 of 14) of patients during the initial and second procedure, respectively. Finally, 32 (86%) patients remained free from AF after the last procedure. Three patients (8%) required pacemaker implantation, one for the gradual progression of sinus dysfunction during a period of 6.5 years and the others for recurrence of TBS 3.5 and 5.5 years after ablation, respectively. CONCLUSION: Catheter ablation can eliminate both AF and prolonged sinus pauses in the majority of TBS patients. Nevertheless, such patients should be continuously followed-up, because gradual progression of sinus node dysfunction can occur after a long period of time.
Inada et al. (Sun,) conducted a cohort in Paroxysmal atrial fibrillation and prolonged sinus pauses (tachycardia-bradycardia syndrome) (n=37). Catheter ablation was evaluated on Freedom from atrial fibrillation after the last procedure. Catheter ablation eliminated both atrial fibrillation and prolonged sinus pauses in 86% of patients with tachycardia-bradycardia syndrome over a 5.8-year follow-up, with only 8% requiring a pacemaker.
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