Incidence and Outcomes of Early Pacemaker Implantation for Sinus Node Dysfunction Following Atrial Fibrillation Ablation

ABSTRACT Introduction Sinus node dysfunction (SND) may be observed following atrial fibrillation ablation (AFA), leading to urgent pacemaker (PPM) implantation. However, the incidence of PPM implantation and the long‐term outcomes are not well known. Objective To assess the incidence and outcomes of PPM implantation for SND immediately after AFA and assess the long‐term requirement for pacing. Methods We conducted a multi‐center, retrospective study of patients who underwent AFA from 2018 to 2024 and received PPM for SND during the same hospitalization. We assessed the patient and procedural characteristics, post‐PPM complications, and atrial pacing percentage (AP%) at 30 and 90 days. Results Of the 8772 patients who underwent AFA, 178 patients (2.0%) received PPM implantation for SND during the same admission. The mean age was 78.6 ± 6.0 years; 48.3% were female, and 51.9% had non‐paroxysmal atrial fibrillation; 14.6% required temporary pacing. PPM implantation was associated with complications, including pocket hematoma (10.7%) and lead malfunction (1.2%). One patient required PPM explantation for pocket erosion following pocket hematoma. At 30 days, 33.1% of patients had AP > 50% with a mean AP% of 34.1 ± 39.2%. At 90 days, 31.5% patients had AP > 50% with a mean AP% of 33.7 ± 39.0%, and 6.7% were PPM‐dependent. Conclusions While the incidence of PPM implantation for Sinus node dysfunction immediately following atrial fibrillation ablation is low, it is associated with an increased risk of complications, especially pocket hematoma. The need for atrial pacing decreased during follow‐up. Hence, extending the monitoring period must be considered before PPM implantation.