Right atrial enlargement prior to catheter ablation predicted the need for pacemaker implantation in patients with tachycardia-bradycardia syndrome (AUC 0.81 for RA/LA area index ratio >0.812).
Cohort (n=103)
What are the clinical predictors of pacemaker implantation after catheter ablation in patients with tachycardia-bradycardia syndrome?
Right atrial enlargement prior to catheter ablation is a significant predictor of the need for subsequent pacemaker implantation in patients with tachycardia-bradycardia syndrome.
Absolute Event Rate: 42.1% vs 21.8%
p-value: p=0.002
Although catheter ablation (CA) of tachycardia-bradycardia syndrome (TBS) in patients with atrial fibrillation (AF) is considered to be an effective treatment strategy, pacemaker implantations (PMIs) are often required even after a successful CA. This study aimed to elucidate the clinical predictors of a PMI after CA. From 2011 to 2020, 103 consecutive patients diagnosed with TBS were retrospectively enrolled in the study. Among the 103 patients, 54 underwent a PMI and 49 CA of AF. During 47.4 ± 35.4 months after 1.4 ± 0.6 CA sessions, 37 (75.5%) of 49 patients were free from atrial arrhythmia recurrences. PMIs were performed in 11 patients (PMI group) and the remaining 38 did not receive a PMI (non-PMI group). When comparing the PMI and non-PMI groups, there were no differences in the basic mean heart rate (P = 0.36), maximum pauses detected by 24-hour Holter-monitoring (P = 0.61), and other clinical parameters between the two groups while the right atrial area index was larger (42.1 ± 24.0 vs. 21.8 ± 8.4 cm 2 /m 2 P = 0.002) in the PMI group than non-PMI group. The ROC curve analysis showed that the optimal cutoff point of the ratio of the right atrial area index to the left atrial area index for predicting a PMI following CA was 0.812 (Sensitivity 72.7%, specificity 71.1%, positive predictive value 42.1%, negative predictive value 90.0%, diagnostic accuracy 71.4%, AUC = 0.81). Right atrial enlargement prior to CA was considered to be one of the risk factors for a PMI after CA of AF.
Arai et al. (Fri,) conducted a cohort in Tachycardia-bradycardia syndrome in patients with atrial fibrillation (n=103). Catheter ablation was evaluated on Right atrial area index in patients requiring vs not requiring pacemaker implantation (p=0.002). Right atrial enlargement prior to catheter ablation predicted the need for pacemaker implantation in patients with tachycardia-bradycardia syndrome (AUC 0.81 for RA/LA area index ratio >0.812).