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KMID : 0368120200500110998
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Korean Circulation Journal
2020 Volume.50 No. 11 p.998 ~ p.1009
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Long-term Clinical Outcomes of Radiofrequency Catheter Ablation versus Permanent Pacemaker Implantation in Patients with Tachycardia-Bradycardia Syndrome
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Cho Sang-Cheol
Jin Eun-Sun
Om Sang-Yong
Hwang Ki-Won
Choi Hyung-Oh
Kim Ki-Hun
Kim Sung-Hwan
Park Kyoung-Min
Kim Jun
Choi Ki-Joon
Kim You-Ho
Nam Gi-Byoung
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Abstract
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Background and Objectives: Pacemaker (PM) implantation is a well-accepted treatment option for patients with paroxysmal atrial fibrillation (AF) and related tachycardia-bradycardia syndrome (TBS). Data on the long-term clinical outcomes after radiofrequency catheter ablation (RFCA) or PM implantation are sparse.
Methods: The medical records of 217 patients with TBS were retrospectively assessed. Outcomes in patients who underwent RFCA (n=108, 49.8%) were compared to those with PM implantation (n=109, 50.2%). The clinical outcomes were sinus rhythm maintenance, conversion to persistent AF, additional procedure or crossover, and the composite of cardiovascular hospitalization and death.
Results: During the follow-up period (mean 3.5±2.0 years), the RFCA group, compared to the PM group, showed better sinus rhythm maintenance (adjusted hazard ratio [aHR], 0.27; 95% confidence interval [CI], 0.15?0.46; p=0.002) and less progression to persistent AF (aHR, 0.20; 95% CI, 0.06?0.63; p=0.006). Additional procedure or crossover did not differ significantly between the groups (aHR, 2.07; 95% CI, 0.71?6.06; p=0.185 and aHR, 0.69; 95% CI, 10.8?2.67; p=0.590, respectively). Most RFCA patients (92.6%) did not require pacemaker implantation during long term follow-up period (>3.5 years). The composite endpoint of cardiovascular rehospitalization and death was not significantly different between the groups (aHR, 0.92; 95% CI, 0.50?1.66; p=0.769).
Conclusions: RFCA is an effective alternative to PM implantation in patients with TBS. In these patients, successful RF ablation of AF is related to a higher rate of sinus rhythm maintenance compared to PM implantation, and the composite outcome of cardiovascular rehospitalization and death is similar.
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KEYWORD
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Atrial fibrillation, Catheter ablation, Pacemaker, artificial
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