Key result
Catheter ablation was superior to antiarrhythmic drug therapy for maintaining freedom from atrial fibrillation at 1 year (55% vs 21%, p=0.02) in patients with persistent AF and sick sinus syndrome.
Why the study?
Does catheter ablation reduce recurrent AF in patients with persistent atrial fibrillation and sick sinus syndrome treated with permanent pacemakers compared to antiarrhythmic drug therapy?
Cohort (n=56)
Does catheter ablation reduce recurrent AF in patients with persistent atrial fibrillation and sick sinus syndrome treated with permanent pacemakers compared to antiarrhythmic drug therapy?
Catheter ablation is highly effective and superior to antiarrhythmic drug therapy for persistent atrial fibrillation in patients with sick sinus syndrome and pacemakers, regardless of the presence of type 2 diabetes.
May support ablation efficacy in T2D with AF/SSS post-pacemaker; hypothesis-generating, needs randomized confirmation before practice change.
Aim. To estimate the efficacy of catheter ablation in patients with type 2 diabetes mellitus (T2D) present with atrial fibrillation and sick sinus syndrome (SSS) undergoing permanent pacemaker implantation. Methods. 56 patients (34 females) with persistent AF and SSS were enrolled in the study. The mean age of patients was 67.7±10.7 years. Dual chamber cardiac pacemaker with remote monitoring function were implanted in all patients. All the patients were assigned to two groups: Group 1 comprised 31 patients aged 67.3±9.6 years, and Group 2 comprised 25 patients aged 72.6±9.9 years, including 22 (39.2%) diabetic patients. 2-3 days after pacemaker implantation, group 1 patients underwent intracardiac electrophysiology study and RFA of the pulmonary vein ostia, mitral isthmus and the left atrial posterior wall. Group 2 patients received antiarrhythmic drug therapy. Results. 3 patients (9%) in Group 1 had recurrent AF within the 6-month follow-up. The efficacy of the RFA for AF was 55% (n = 17) 1 year after the indexed hospitalization. 8 patients had short paroxysmal attacks which gradually lessened and stopped after. 5 patients (21%) in Group 2 did not have any AF paroxysms within the 1-year follow-up (Х2 = 5.52, р = 0.02). All these patients received amiodarone as antiarrhythmic drug therapy, whereas the others had paroxysmal attacks. Frequent attacks in 10 patients (40%) led to a change in antiarrhythmic drug use. Hospital readmission rates for AF were 16% and 52%, respectively (Х2 = 4.15, р = 0.04). The impact of atrial and ventricular stimulation on the development of recurrent AF was statistically insignificant (atrial stimulation – X2 = 0.01, cc = 1, p = 0.90; ventricular stimulation – X2 = 0.15, cc = 1, p = 0.69). None paroxysmal attacks were recorded in 10 diabetic patients (45%) after the RFA within the 1-year follow-up. Conclusion. Catheter ablation for persistent AF and SSS treated with permanent pacemakers is highly effective and safe method. In addition, it is superior to pharmacological approach. The presence of T2D likely did not significantly affect the efficacy of RFA for persistent form of AF.
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Арчаков et al. (2018) conducted a cohort in Persistent atrial fibrillation and sick sinus syndrome (n=56). Radiofrequency catheter ablation vs. Antiarrhythmic drug therapy was evaluated on Freedom from atrial fibrillation paroxysms at 1 year (p=0.02). Catheter ablation was superior to antiarrhythmic drug therapy for maintaining freedom from atrial fibrillation at 1 year (55% vs 21%, p=0.02) in patients with persistent AF and sick sinus syndrome.
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