Key result
Catheter ablation linked to ~83% lower odds of major events vs pacing in tachycardia-bradycardia syndrome.
Why the study?
Catheter ablation of AF is an alternative treatment to avoid pacemaker implantation in tachycardia-bradycardia syndrome, but risk stratification for AF and comparative outcomes between ablation and pacing have not been fully evaluated.
Does catheter ablation reduce the composite of all-cause mortality, cardiovascular-related hospitalization, or thrombosis events compared to pacemaker implantation in patients with tachycardia-bradycardia syndrome?
Cohort (n=306)
No
Does catheter ablation reduce the composite of all-cause mortality, cardiovascular-related hospitalization, or thrombosis events compared to pacemaker implantation in patients with tachycardia-bradycardia syndrome?
Effect estimate: OR 6.05 (95% CI 3.73-9.80)
Absolute Event Rate: 14.2% vs 59.4%
p-value: p=<0.001
In patients with tachycardia-bradycardia syndrome, catheter ablation significantly reduced the composite of cardiovascular hospitalization and thromboembolic events compared to pacemaker implantation.
Ablation was associated with fewer events in this cohort; leaves open whether randomized trials would confirm benefit over pacing.
Background: Catheter ablation of atrial fibrillation is an alternative treatment for patients with tachycardia-bradycardia syndrome (TBS) to avoid pacemaker implantation. The risk stratification for atrial fibrillation and outcomes between ablation and pacing has not been fully evaluated. Methods: This retrospective study involved 306 TBS patients, including 141 patients who received catheter ablation (Ablation group, age: 62.2 ± 9.0 months, mean longest pauses: 5.2 ± 2.2 s) and 165 patients who received pacemaker implement (Pacing group, age: 62.3 ± 9.1 months, mean longest pauses: 6.0 ± 2.3 s). The primary endpoint was a composite of call cause mortality, cardiovascular-related hospitalization or thrombosis events (stroke, or peripheral thrombosis). The second endpoint was progress of atrial fibrillation and heart failure. Results: After a median follow-up of 75.4 months, the primary endpoint occurred in significantly higher patients in the pacing group than in the ablation group (59.4 vs.15.6%, OR 6.05, 95% CI: 3.73–9.80, P < 0.001). None of deaths was occurred in ablation group, and 1 death occurred due to cancer. Cardiovascular-related hospitalization occurred in 50.9% of the pacing group compared with 14.2% in the ablation group (OR: 4.87, 95% CI: 2.99–7.95, P < 0.001). More thrombosis events occurred in the pacing group than in the ablation group (12.7 vs. 2.1%, OR 6.06, 95% CI: 1.81–20.35, P = 0.004). Significant more patients progressed to persistent atrial fibrillation in pacing group than in ablation group (23.6 vs. 2.1%, P < 0.001). The NYHA classification of the pacing group was significantly higher than that of the ablation group (2.11 ± 0.83 vs. 1.50 ± 0.74, P < 0.001). The proportion of antiarrhythmic drugs and anticoagulants used in the pacing group was significantly higher than that in the ablation group (41.2 vs. 7.1%, P < 0.001; 16.4 vs. 2.1%, P = 0.009). Conclusion: Catheter ablation for patients with TBS was associated with a significantly lower rate of a composite end point of cardiovascular related hospitalization and thromboembolic events. Furthermore, catheter ablation reduced the progression of atrial fibrillation and heart failure.
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Zhang et al. (2021) conducted a cohort in Tachycardia-bradycardia syndrome (n=306). Catheter ablation vs. Pacemaker implantation was evaluated on Composite of all-cause mortality, cardiovascular-related hospitalization, or thrombosis events (OR 6.05, 95% CI 3.73-9.80, p=<0.001). Catheter ablation reduced the composite of mortality, cardiovascular hospitalization, and thrombosis compared to pacing in tachycardia-bradycardia syndrome patients (14.2% vs 59.4%, OR 6.05).
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