Key result
Sick sinus syndrome linked to ~124% higher AF recurrence after catheter ablation.
Why the study?
Does the presence of sick sinus syndrome increase the risk of atrial fibrillation recurrence in patients undergoing catheter ablation for paroxysmal atrial fibrillation?
Case-Control (n=216)
No
Does the presence of sick sinus syndrome increase the risk of atrial fibrillation recurrence in patients undergoing catheter ablation for paroxysmal atrial fibrillation?
Absolute Event Rate: 26.9% vs 12%
p-value: p=0.02
Patients with sick sinus syndrome have a significantly higher risk of atrial fibrillation recurrence after catheter ablation for paroxysmal AF, which is strongly associated with a higher prevalence of non-pulmonary vein foci.
SSS was associated with higher post-ablation AF recurrence; leaves open whether targeting non-PV foci improves outcomes.
BACKGROUND: The clinical efficacy of catheter ablation (CA) for paroxysmal atrial fibrillation (PAF) in patients with sick sinus syndrome (SSS) and the mechanism and predictors of recurrence are not yet completely elucidated. METHODS AND RESULTS: Of 963 consecutive patients who underwent PAF ablation during the study period, a total of 108 patients with SSS (SSS group) and 108 matched controls without SSS (non-SSS group) were followed up. During the follow-up period (mean, 32.8±17.5 months), the SSS group had significantly higher AF recurrence rate since the last procedure than the non-SSS group (26.9% vs. 12.0%; P=0.02). The SSS group had significantly higher prevalence of non-pulmonary vein (non-PV) foci than the non-SSS group (25.9% vs. 13.9%; P=0.027). On multivariate analysis congestive heart failure (HR, 13.7; 95% CI: 1.57-119; P=0.02) and non-PV foci (HR, 5.75; 95% CI: 1.69-19.6; P=0.005) were independent predictors of recurrence following CA in the SSS group. In the SSS group, 88 patients had bradycardia-tachycardia syndrome without prior permanent pacemaker implantation. Of these, 6 required pacemaker implantation because of AF and sinus pause recurrence. CONCLUSIONS: Patients with SSS are at higher risk of AF recurrence after CA. Non-PV foci are associated with AF recurrence following PAF with SSS.
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Hayashi et al. (2016) conducted a case-control in Paroxysmal Atrial Fibrillation with Sick Sinus Syndrome (n=216). Catheter ablation vs. Matched cohort without sick sinus syndrome was evaluated on Atrial fibrillation recurrence after the last procedure (p=0.02). Patients with sick sinus syndrome had a significantly higher rate of atrial fibrillation recurrence after catheter ablation compared to matched controls without sick sinus syndrome (26.9% vs. 12.0%).
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