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KMID : 0368120200500040346
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Korean Circulation Journal
2020 Volume.50 No. 4 p.346 ~ p.357
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Permanent Pacemaker Implantations after Catheter Ablation in Patients with Atrial Fibrillation Associated with Underlying Sinus Node Dysfunction
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Hwang Tae-Hyun
Yu Hee-Tae
Kim Tae-Hoon
Uhm Jae-Sun
Kim Jong-Youn
Joung Bo-Young
Lee Moon-Hyoung
Pak Hui-Nam
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Abstract
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Background and Objectives: The objective of this study was to evaluate the long-term clinical outcomes and the incidence of permanent pacemaker implantation after catheter ablation in patients with of atrial fibrillation (AF) and sinus node dysfunction (SND).
Methods: Among 3,068 total consecutive patients who underwent AF catheter ablation (AFCA), this study included 222 (9.5%; men 53.2%, 63.7±9.2 years of age, 81.5% paroxysmal AF) with underlying SND and a regular rhythm follow-up. We analyzed the rhythm outcomes, changes in the mean heart rate or heart rate variability, and permanent pacemaker implantation rate.
Results: During 47.5±28.8 months of follow-up, 25 (11.3%) patients received pacemaker implantations due to symptomatic SND. More than half (56.0%, 14/25) underwent a pacemaker implantation within 3 months of the AFCA, and the annual pacemaker implantation rate was 2.0% afterwards. Both the early (68.0% vs. 31.0%, p<0.001) and clinical AF recurrence (68.0% vs. 32.5%, p=0.001) rates and continuous antiarrhythmic drug use after 3 months (44.0% vs. 24.4%, p=0.036) were significantly higher in patients requiring pacemaker implantations than those that did not. An anterior linear ablation (odds ratio [OR], 9.37 [3.03?28.9]; p<0.001) and the E/Em (OR, 1.15 [1.02?1.28]; p=0.018) were independently associated with permanent pacemaker implantations after AFCA in patients with AF and SND.
Conclusions: After AFCA in patients with AF and SND, 1 of 9 patients needed a pacemaker implantation and half needed implantations within 3 months. The AF recurrence rate was significantly higher in those who required pacemaker implantations after the AFCA.
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KEYWORD
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Sinus node dysfunction, Atrial fibrillation, Catheter ablation, Pacemaker, artificial
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