Early versus late Catheter Ablation of Atrial Fibrillation and Risk of Permanent Pacemaker Implantation in patients with underlying Sinus Node Dysfunction

• Published in: Journal of the American Heart Association 2022-09, Vol.11 (17), p.e023333-e023333
• Main Authors: Umer Butt, Muhammad, Okumus, Nazli, Jabri, Ahmad, Thomas, Charles, Tarabichi, Yasir, Karim, Saima
• Format: Article
• Language: English
• Subjects: atrial fibrillation ablation; atrial fibrillation duration; pacemaker implantation; sick sinus syndrome
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.121.023333

Background Atrial fibrillation (AF) is associated with anatomical and electrical remodeling. Some patients with AF have concomitant sick sinus syndrome (SSS) and may need permanent pacemaker (PPM) implantation. Association between catheter ablation of AF (CA) timing and need for PPM in SSS has not been assessed. Methods and Results We used pooled electronic health data to perform retrospective cross-sectional analysis of 66,595 patients with AF and SSS to assess the need of PPM implantation temporally with atrial fibrillation performed earlier within 5 years (group 1), 5-10 years (group 2), or beyond 10 years (group 3) of diagnosis. PPM implantation was lowest amongst those who had CA within 5 years of SSS diagnosis; group 1 versus group 2 (18.15 % vs 27.21 %) and group 1 versus group 3 (18.15 % vs 27.22%). Interestingly, there was no difference in risk of PPM between group 2 and group 3 (27.21 % vs 27.22 %, OR 1.00 [0.85- 1.20]). Conclusion Even after controlling known risk factors that increase the need for pacemaker implantation, timing of AF ablation was the strongest predictor for need for PPM. Patients adjusted odds (aOR) of PPM was lower if patient had CA within 5 years of diagnosis as compared to later than 5 years (aOR 0.64 [0.59- 0.70]).