title: The role of successful catheter ablation in patients with paroxysmal atrial fibrillation and prolonged sinus pauses: outcome during a 5-year follow-up.
abstract: OBJECTIVE
  Although patients with paroxysmal atrial fibrillation (AF) and prolonged sinus pauses [tachycardia-bradycardia syndrome (TBS)] are generally treated by permanent pacemaker, catheter ablation has been reported to be a curative therapy for TBS without pacemaker implantation. The purpose of this study was to define the potential role of successful ablation in patients with TBS.
  
  
  RESULTS
  Of 280 paroxysmal AF patients undergoing ablation, 37 TBS patients with both AF and symptomatic sinus pauses (age: 62 ± 8 years; mean maximum pauses: 6 ± 2 s) were analysed. During the 5.8 ± 1.2 years (range: 5-8.7 years) follow-up, both tachyarrhythmia and bradycardia were eliminated by a single procedure in 19 of 37 (51%) patients. Repeat procedures were performed in 14 of 18 patients with tachyarrhythmia recurrence (second: 12 and third: 2 patients). During the repeat procedure, 79% (45 of 57) of previously isolated pulmonary veins (PVs) were reconnected to the left atrium. Pulmonary vein tachycardia initiating the AF was found in 46% (17 of 37) and 43% (6 of 14) of patients during the initial and second procedure, respectively. Finally, 32 (86%) patients remained free from AF after the last procedure. Three patients (8%) required pacemaker implantation, one for the gradual progression of sinus dysfunction during a period of 6.5 years and the others for recurrence of TBS 3.5 and 5.5 years after ablation, respectively.
  
  
  CONCLUSIONS
  Catheter ablation can eliminate both AF and prolonged sinus pauses in the majority of TBS patients. Nevertheless, such patients should be continuously followed-up, because gradual progression of sinus node dysfunction can occur after a long period of time.
authors.affiliation: Department of Cardiology, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8471, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Inada
authors.forename: Teiichi
authors.initials: T
authors.lastname: Yamane
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Tokutake
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Yokoyama
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Mishima
authors.forename: Mika
authors.initials: M
authors.lastname: Hioki
authors.forename: Ryohsuke
authors.initials: R
authors.lastname: Narui
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ito
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Tanigawa
authors.forename: Seigo
authors.initials: S
authors.lastname: Yamashita
authors.forename: Michifumi
authors.initials: M
authors.lastname: Tokuda
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Matsuo
authors.forename: Kenri
authors.initials: K
authors.lastname: Shibayama
authors.forename: Satoru
authors.initials: S
authors.lastname: Miyanaga
authors.forename: Taro
authors.initials: T
authors.lastname: Date
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yoshimura
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation / Q000009:adverse effects; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012804:Sick Sinus Syndrome / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D054138:Sinus Arrest, Cardiac / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Brady-tachycardia syndrome; Catheter ablation; Long-term outcome; Sinus node dysfunction