title: Pacemaker implantation after catheter ablation for atrial fibrillation.
abstract: BACKGROUND
  Sinus node dysfunction requiring pacemaker implantation is commonly associated with atrial fibrillation (AF), but may not be clinically apparent until restoration of sinus rhythm with ablation or cardioversion. We sought to determine frequency, time course, and predictors for pacemaker implantation after catheter ablation, and to compare the overall rates to a matched cardioversion cohort.
  
  
  RESULTS
  We conducted a retrospective analysis using a large US commercial insurance database and identified 12,158 AF patients who underwent catheter ablation between January 1, 2005 and December 31, 2012. Over an average of 2.4 years of follow-up, 5.6 % of the patients underwent pacemaker implantation. Using the Cox proportional hazards models, we found that risk of risks of pacemaker implantation was associated with older age (50-64 and ≥65 versus <50 years), female gender, higher CHADS2 score (≥2 and 1 versus 0), higher Charlson index (≥2 versus 0-1), certain baseline comorbidities (conduction disorder, coronary atherosclerosis, and congestive heart failure), and the year of ablation. There was no significant difference in the risk of pacemaker implantation between ablation patients and propensity score (PS)-matched cardioversion groups (3.5 versus. 4.1 % at 1 year and 8.8 versus 8.3 % at 5 years).
  
  
  CONCLUSIONS
  Overall, pacemaker implantation occurs in about 1/28 patients within 1 year of catheter ablation. The overall implantation rate decreased between 2005 and 2012. Furthermore, the risk after ablation is similar to cardioversion, suggesting that patients require pacing due to a common underlying electrophysiologic substrate, rather than the ablation itself.
authors.affiliation: Cardiovascular Diseases, Mayo Clinic Heart Rhythm Section, Rochester, MN, USA.
authors.forename: Abhishek J
authors.initials: AJ
authors.lastname: Deshmukh
authors.affiliation: Mayo Clinic Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Rochester, MN, USA.|Optum Labs, Cambridge, MA, USA.
authors.forename: Xiaoxi
authors.initials: X
authors.lastname: Yao
authors.affiliation: Mayo Clinic Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Rochester, MN, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Schilz
authors.affiliation: Mayo Clinic Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Rochester, MN, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Van Houten
authors.affiliation: Mayo Clinic Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Rochester, MN, USA.
authors.forename: Lindsey R
authors.initials: LR
authors.lastname: Sangaralingham
authors.affiliation: Cardiovascular Diseases, Mayo Clinic Heart Rhythm Section, Rochester, MN, USA.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Asirvatham
authors.affiliation: Cardiovascular Diseases, Mayo Clinic Heart Rhythm Section, Rochester, MN, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Friedman
authors.affiliation: Cardiovascular Diseases, Mayo Clinic Heart Rhythm Section, Rochester, MN, USA.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Packer
authors.affiliation: Cardiovascular Diseases, Mayo Clinic Heart Rhythm Section, Rochester, MN, USA. noseworthy.peter@mayo.edu.|Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, 55902, USA. noseworthy.peter@mayo.edu.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Noseworthy
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D017115:Catheter Ablation / Q000401:mortality* / Q000706:statistics & numerical data*; D003131:Combined Modality Therapy / Q000401:mortality / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000401:mortality*; D015995:Prevalence; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014600:Utilization Review
keywords: Ablation; Atrial fibrillation; Epidemiology; Pacemaker