Pacing or ablation: which is better for paroxysmal atrial fibrillation-related tachycardia-bradycardia syndrome?
BACKGROUND
Symptomatic prolonged sinus pauses on termination of atrial fibrillation (AF) are an accepted indication for pacemaker implantation. We evaluated the outcome of AF ablation in patients with paroxysmal AF-related tachycardia-bradycardia syndrome and compared the efficacy of catheter ablation with permanent pacing plus antiarrhythmic drugs (AADs).


RESULTS
Patients with prolonged symptomatic sinus pauses on termination of AF were retrospectively analyzed. Forty-three consecutive patients who underwent catheter ablation (ABL group) were compared to 57 patients who underwent permanent pacing plus AADs (PM group). All 43 patients in the ABL group fulfilled Class I indication for pacemaker implantation at baseline but they actually underwent AF ablation. Reevaluation after 20.1 ± 9.6 months of follow-up showed that 41 patients (95.3%) did no longer need a pacemaker (Class III indication). Total cardiac-related rehospitalization was not significantly different between the two groups (P = 0.921). Tachycardia-related hospitalization was significantly higher in the PM group than the ABL group (14.0% and 0%, P = 0.029). More patients in the PM group were on AADs (PM 40.4%, ABL 4.7%, P < 0.001) while sinus rhythm maintenance was remarkably higher in the ABL group at the end of follow-up (83.7% vs 21.1% in PM group, P < 0.001).


CONCLUSIONS
In patients with paroxysmal AF-related tachycardia-bradycardia syndrome, AF ablation seems to be superior to a strategy of pacing plus AAD. Pacemaker implantation can be waived in the majority of patients after a successful ablation.
Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China.
Ying-Wei
YW
Chen
Rong
R
Bai
Tao
T
Lin
Mohamed
M
Salim
Cai-Hua
CH
Sang
De-Yong
DY
Long
Rong-Hui
RH
Yu
Ri-Bo
RB
Tang
Xue-Yuan
XY
Guo
Xian-Liang
XL
Yan
Jun-Gang
JG
Nie
Xin
X
Du
Jian-Zeng
JZ
Dong
Chang-Sheng
CS
Ma
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000706:statistics & numerical data*; D002681:China; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012804:Sick Sinus Syndrome / Q000175:diagnosis / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents
atrial fibrillation; catheter ablation; pacemaker; sinus node dysfunction