Key result
Radiofrequency catheter ablation was associated with better sinus rhythm maintenance than pacemaker implantation in patients with tachycardia-bradycardia syndrome (aHR 0.27; 95% CI 0.15-0.46; p=0.002).
Why the study?
Data on long-term clinical outcomes after radiofrequency catheter ablation or pacemaker implantation in patients with paroxysmal AF and related tachycardia-bradycardia syndrome were sparse.
Does radiofrequency catheter ablation improve sinus rhythm maintenance and reduce cardiovascular hospitalization or death compared to permanent pacemaker implantation in patients with tachycardia-bradycardia syndrome?
Cohort (n=217)
Does radiofrequency catheter ablation improve sinus rhythm maintenance and reduce cardiovascular hospitalization or death compared to permanent pacemaker implantation in patients with tachycardia-bradycardia syndrome?
Hazard Ratio: 0.27 (95% CI 0.15–0.46)
p-value: p=0.002
Radiofrequency catheter ablation is an effective alternative to pacemaker implantation in tachycardia-bradycardia syndrome, offering better sinus rhythm maintenance without increasing cardiovascular hospitalization or death.
Supports RFCA consideration in tachycardia-bradycardia syndrome; leaves open confirmation of outcomes in randomized trials.
BACKGROUND AND OBJECTIVES: Pacemaker (PM) implantation is a well-accepted treatment option for patients with paroxysmal atrial fibrillation (AF) and related tachycardia-bradycardia syndrome (TBS). Data on the long-term clinical outcomes after radiofrequency catheter ablation (RFCA) or PM implantation are sparse. METHODS: The medical records of 217 patients with TBS were retrospectively assessed. Outcomes in patients who underwent RFCA (n=108, 49.8%) were compared to those with PM implantation (n=109, 50.2%). The clinical outcomes were sinus rhythm maintenance, conversion to persistent AF, additional procedure or crossover, and the composite of cardiovascular hospitalization and death. RESULTS: During the follow-up period (mean 3.5±2.0 years), the RFCA group, compared to the PM group, showed better sinus rhythm maintenance (adjusted hazard ratio [aHR], 0.27; 95% confidence interval [CI], 0.15-0.46; p=0.002) and less progression to persistent AF (aHR, 0.20; 95% CI, 0.06-0.63; p=0.006). Additional procedure or crossover did not differ significantly between the groups (aHR, 2.07; 95% CI, 0.71-6.06; p=0.185 and aHR, 0.69; 95% CI, 10.8-2.67; p=0.590, respectively). Most RFCA patients (92.6%) did not require pacemaker implantation during long term follow-up period (>3.5 years). The composite endpoint of cardiovascular rehospitalization and death was not significantly different between the groups (aHR, 0.92; 95% CI, 0.50-1.66; p=0.769). CONCLUSIONS: RFCA is an effective alternative to PM implantation in patients with TBS. In these patients, successful RF ablation of AF is related to a higher rate of sinus rhythm maintenance compared to PM implantation, and the composite outcome of cardiovascular rehospitalization and death is similar.
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Cho et al. (2020) conducted a cohort in Tachycardia-bradycardia syndrome and paroxysmal atrial fibrillation (n=217). Radiofrequency catheter ablation vs. Permanent pacemaker implantation was evaluated on Sinus rhythm maintenance (aHR 0.27, 95% CI 0.15-0.46, p=0.002). Radiofrequency catheter ablation was associated with better sinus rhythm maintenance than pacemaker implantation in patients with tachycardia-bradycardia syndrome (aHR 0.27; 95% CI 0.15-0.46; p=0.002).
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