Key result
Pre-existing sinus node dysfunction in paroxysmal atrial fibrillation patients significantly increased the 5-year risk of pacemaker implantation after ablation to 14.8% compared to 1.7% in those without.
Why the study?
Does pre-existing bradycardia increase the subsequent need for permanent pacemaker implantation in patients undergoing first-time radiofrequency catheter ablation for atrial fibrillation?
Cohort (n=1,131)
No
Does pre-existing bradycardia increase the subsequent need for permanent pacemaker implantation in patients undergoing first-time radiofrequency catheter ablation for atrial fibrillation?
Pre-existing sinus node dysfunction or slow ventricular response significantly increases the 5-year risk of needing a permanent pacemaker after AF ablation, particularly in females and the elderly.
Answers are grounded in this paper and cite their sources.
May prompt closer post-ablation pacemaker monitoring in SND; hypothesis-generating and requires prospective validation.
BACKGROUND: The incidence of subsequent need for permanent pacemaker implantation (PMI) after radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) in real world patients with and without pre-existing bradycardia has not yet been fully evaluated. METHODS AND RESULTS: A total of 1,131 consecutive patients undergoing first-time RFCA for AF who had no previous or planned device implantation, were enrolled in the present study. Of 799 paroxysmal AF (PAF) patients, 121 (15.1%) had sinus node dysfunction (SND). Of 332 non-PAF patients, 73 (22.0%) had slow ventricular response (VR), defined as heart rate <80 beats/min at rest without any rate-control drugs. The 5-year cumulative incidence of PMI after RFCA in PAF patients with and without SND was 14.8% and 1.7%, respectively (P<0.001). The 5-year cumulative incidence of PMI after RFCA in non-PAF patients with and without slow VR was 14.8% and 4.7%, respectively (P<0.001). SND and female gender in PAF patients, as well as slow VR and age ≥75 years in non-PAF patients, were independent and additive predictors of PMI. The 5-year cumulative incidence of PMI was 26.3% in female PAF patients with SND and 33.3% in elderly non-PAF patients with slow VR. CONCLUSIONS: PMI was avoided in >85% of patients undergoing RFCA for PAF with pre-existing SND, although care should be taken for female patients. Decision-making regarding RFCA for non-PAF patients with slow VR, especially in the elderly, should be cautious.
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Kawaji et al. (2018) conducted a cohort in Atrial fibrillation (n=1,131). Pre-existing sinus node dysfunction vs. Absence of sinus node dysfunction was evaluated on 5-year cumulative incidence of permanent pacemaker implantation in paroxysmal atrial fibrillation patients (HR 7.44, 95% CI 3.60-15.9, p=<0.001). Pre-existing sinus node dysfunction in paroxysmal atrial fibrillation patients significantly increased the 5-year risk of pacemaker implantation after ablation to 14.8% compared to 1.7% in those without.
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