Key result
Having a permanent pacemaker for atrioventricular block independently predicted a higher risk of atrial fibrillation recurrence after catheter ablation compared to matched controls (HR 2.095).
Why the study?
Does the presence of a permanent pacemaker for atrioventricular block increase the risk of atrial fibrillation recurrence after catheter ablation in patients with paroxysmal atrial fibrillation?
Cohort (n=174)
No
Does the presence of a permanent pacemaker for atrioventricular block increase the risk of atrial fibrillation recurrence after catheter ablation in patients with paroxysmal atrial fibrillation?
Hazard Ratio: 2.095 (95% CI 1.109–3.96)
Absolute Event Rate: 48.3% vs 27.6%
p-value: p=0.023
Patients with a permanent pacemaker for atrioventricular block are at a significantly increased risk of atrial fibrillation recurrence following catheter ablation compared to matched controls.
Should not yet alter ablation decisions in paced patients; leaves open causal mechanisms and need for prospective validation.
Catheter ablation has been established to be an effective therapy for drug-refractory paroxysmal AF and is recommended as the treatment of choice for many patients, including those with a permanent pacemaker (PM). However, the clinical efficacy of catheter ablation of paroxysmal AF in patients with a permanent PM for atrioventricular block (AVB) is not clear. Twenty-nine patients with a permanent PM for AVB (AVB + PM group), and 145 age- and gender-matched control patients (on a 1:5 basis) without AVB and without a permanent PM (no-AVB + no-PM group), were included in this study. Atrial fibrillation (AF) recurrence was defined as the occurrence of confirmed atrial tachyarrhythmia lasting more than 30 seconds beyond 3 months after catheter ablation in the absence of any antiarrhythmic treatment. During a mean follow-up period of 14.2 ± 8.6 months (range, 3-30 months), 54 patients (31.0%) developed recurrence of AF. The recurrence rate was higher in the AVB + PM group than in the no-AVB + no-PM group (48.3% versus 27.6%, P = 0.005). Cox regression analysis with adjustment for age, valvular heart disease, AVB and a PM together, left atrial (LA) diameter and PV isolation identified LA diameter (hazard ratio 1.054, 95% confidence interval 1.001-1.110, P = 0.047) and AVB and a PM together (hazard ratio 2.095, 95% confidence interval 1.109-3.960, P = 0.023) as two independent predictors of recurrence of AF. Patients with a permanent PM for AVB were at an increased risk of recurrence of AF after catheter ablation.
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Wu et al. (2014) conducted a cohort in Paroxysmal atrial fibrillation (n=174). Permanent pacemaker for atrioventricular block vs. No atrioventricular block and no permanent pacemaker was evaluated on Recurrence of atrial fibrillation (HR 2.095, 95% CI 1.109-3.960, p=0.023). Having a permanent pacemaker for atrioventricular block independently predicted a higher risk of atrial fibrillation recurrence after catheter ablation compared to matched controls (HR 2.095).
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