Key result
Catheter ablation within 5 years of sick sinus syndrome diagnosis was associated with a lower risk of permanent pacemaker implantation compared with later ablation (adjusted OR 0.64; 95% CI 0.59-0.70).
Why the study?
The association between the timing of catheter ablation of AF and the need for PPM implantation in sick sinus syndrome had not been assessed.
Does early catheter ablation of atrial fibrillation reduce the need for permanent pacemaker implantation in patients with atrial fibrillation and sick sinus syndrome?
Cross-Sectional (n=66,595)
Does early catheter ablation of atrial fibrillation reduce the need for permanent pacemaker implantation in patients with atrial fibrillation and sick sinus syndrome?
Odds Ratio: 0.64 (95% CI 0.59–0.7)
Early catheter ablation (within 5 years of diagnosis) in patients with atrial fibrillation and sick sinus syndrome is associated with a significantly lower risk of requiring permanent pacemaker implantation compared to later ablation.
Early AF ablation was associated with lower PPM need; leaves open whether timing modifies risk in prospective cohorts.
Background Atrial fibrillation (AF) is associated with anatomical and electrical remodeling. Some patients with AF have concomitant sick sinus syndrome and may need permanent pacemaker (PPM) implantation. Association between catheter ablation of AF timing and need for PPM in sick sinus syndrome has not been assessed. Methods and Results We used pooled electronic health data to perform retrospective cross-sectional analysis of 66, 595 patients with AF and sick sinus syndrome to assess the need of PPM implantation temporally, with AF performed divided into earlier within 5 years (group 1), 5 to 10 years (group 2), or beyond 10 years (group 3) of diagnosis. PPM implantation was lowest among those who had catheter ablation within 5 years of sick sinus syndrome diagnosis: group 1 versus group 2 (18.15% versus 27.21%) and group 1 versus group 3 (18.15% versus 27.22%). Interestingly, there was no difference in risk of PPM between group 2 and group 3 (27.21% versus 27.22%; odds ratio [OR], 1.00 [95% CI, 0.85-1.20]). Conclusions Even after controlling known risk factors that increase the need for pacemaker implantation, timing of AF ablation was the strongest predictor for need for PPM. Patients adjusted OR of PPM was lower if patients had catheter ablation within 5 years of diagnosis compared with later than 5 years (adjusted OR, 0.64 [95% CI, 0.59-0.70]).
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Butt et al. (2022) conducted a cross-sectional in Atrial fibrillation and sick sinus syndrome (n=66,595). Early catheter ablation (within 5 years of diagnosis) vs. Late catheter ablation (later than 5 years of diagnosis) was evaluated on Permanent pacemaker implantation (adjusted OR 0.64, 95% CI 0.59-0.70). Catheter ablation within 5 years of sick sinus syndrome diagnosis was associated with a lower risk of permanent pacemaker implantation compared with later ablation (adjusted OR 0.64; 95% CI 0.59-0.70).
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