title: Pulmonary vein isolation for atrial fibrillation in patients with symptomatic sinus bradycardia or pauses.
abstract: BACKGROUND
  Sick sinus syndrome is commonly associated with tachyarrhythmias and bradyarrhythmias that often are symptomatic. The aim of this study was to assess the effect of pulmonary vein isolation in patients with sick sinus syndrome and atrial fibrillation (AF).
  
  
  RESULTS
  Three hundred fourteen consecutive patients who underwent pulmonary vein isolation between December 2000 and January 2002 were included in the study. Thirty-one patients had sick sinus syndrome, which was defined as a preprocedural history of symptomatic sinus bradycardia or pauses. Endpoints included AF recurrence, change in the frequency of sinus pauses, and symptoms of presyncope or syncope, as well as mean heart rate and percentage of atrial pacing in patients with pacemakers implanted prior to the pulmonary vein isolation. Patients had AF for an average of 6 +/- 3 years. Patients were 58 +/-8 years old and had ejection fractions of 55 +/- 4%. Sixty-one percent had implanted pacemakers. AF recurred within 6 months in 4 patients. Two had a successful second pulmonary vein isolation procedure. There were no recurrences of presyncopal events (P < 0.05) or documented sinus pauses (P < 0.05) after successful pulmonary vein isolation in the patients without permanent pacemakers. Patients with pacemakers had a 13-fold reduction in the percentage of atrial pacing (P < 0.05). Both groups showed a significant increase in average heart rates at 6-month follow-up.
  
  
  CONCLUSIONS
  Cure of AF by pulmonary vein isolation helped resolve the clinical manifestations of sick sinus syndrome, suggesting that the occurrence of AF and/or the associated treatment could be partially responsible for sick sinus syndrome.
authors.affiliation: Center for Atrial Fibrillation, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Yaariv
authors.initials: Y
authors.lastname: Khaykin
authors.forename: Nassir F
authors.initials: NF
authors.lastname: Marrouche
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.forename: Robert
authors.initials: R
authors.lastname: Schweikert
authors.forename: Mark
authors.initials: M
authors.lastname: Wexman
authors.forename: Brian
authors.initials: B
authors.lastname: Strunk
authors.forename: Salwa
authors.initials: S
authors.lastname: Beheiry
authors.forename: Eduardo
authors.initials: E
authors.lastname: Saad
authors.forename: Mandeep
authors.initials: M
authors.lastname: Bhargava
authors.forename: J David
authors.initials: JD
authors.lastname: Burkhardt
authors.forename: George
authors.initials: G
authors.lastname: Joseph
authors.forename: Patrick
authors.initials: P
authors.lastname: Tchou
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D016009:Chi-Square Distribution; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011667:Pulmonary Veins; D012008:Recurrence; D012804:Sick Sinus Syndrome / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome