Pacemaker implantation after catheter ablation for atrial fibrillation

Abstract Aims The sex-related differences in the clinical outcomes of rhythm and safety after catheter ablation remain unclear. The purpose of this study was to compare the clinical outcomes of catheter ablation for atrial fibrillation (AF) in women and men. Methods and results The Medline and EMBASE databases were searched for published articles up to December 2018. Studies that met our predefined inclusion criteria were included. The primary endpoints were freedom from AF/atrial tachycardia (AT) recurrence, stroke/transient ischaemic attack (TIA), and all-cause mortality. After literature search and detailed assessment, 19 observational studies (151 370 patients; 34% women) were identified. Our analyses showed that the rate of freedom from AF/AT recurrence was lower in women than men at the 2.4-year follow-up [odds ratio (OR): 0.75, 95% confidence interval (CI) 0.69–0.81; P < 0.0001]. Moreover, women had an increased risk of stroke/TIA (OR: 1.42, 95% CI 1.21–1.67; P < 0.0001) and all-cause mortality (OR: 1.53, 95% CI 1.02–2.28; P = 0.04). Nevertheless, for the endpoint of all-cause mortality, there was no significant difference between the two genders in the subgroup of prospective studies (OR: 1.19, 95% CI 0.69–2.05; P = 0.53). Additionally, women were more likely to experience major complications compared with men (pericardial effusion/tamponade, major bleeding requiring transfusion, and pacemaker implantation). Conclusions Women who underwent catheter ablation of AF might experience lower efficacy and a higher risk of stroke/TIA and major complications than men. The reasons for these sex-related differences need to be further studied.

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CATHETER ABLATION IMPROVES QUALITY OF LIFE IN PATIENTS WITH ATRIAL FIBRILLATION AND PREVIOUS ATRIOVENTRICULAR JUNCTION ABLATION FOLLOWED BY PACEMAKER IMPLANTATION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(12)60607-x ◽

2012 ◽

Vol 59 (13) ◽

pp. E606

Author(s):

Sanghamitra Mohanty ◽

Prasant Mohanty ◽

Di Biase Luigi ◽

Rong Bai ◽

Pasquale Santangeli ◽

...

Keyword(s):

Quality Of Life ◽

Atrial Fibrillation ◽

Catheter Ablation ◽

Pacemaker Implantation ◽

Atrioventricular Junction

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FREQUENCY AND PREDICTORS OF PACEMAKER IMPLANTATION AFTER CATHETER ABLATION OR CARDIOVERSION FOR ATRIAL FIBRILLATION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(15)60309-6 ◽

2015 ◽

Vol 65 (10) ◽

pp. A309

Author(s):

Peter Noseworthy ◽

Abhishek Deshmukh ◽

Haas Lindsey ◽

Van Houten Holly ◽

Schilz Sara ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Pacemaker Implantation

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Risk Stratification for Atrial Fibrillation and Outcomes in Tachycardia-Bradycardia Syndrome: Ablation vs. Pacing

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.674471 ◽

2021 ◽

Vol 8 ◽

Author(s):

Rongfeng Zhang ◽

Yue Wang ◽

Minghui Yang ◽

Yiheng Yang ◽

Zhengyan Wang ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Catheter Ablation ◽

Risk Stratification ◽

Primary Endpoint ◽

Pacemaker Implantation ◽

Persistent Atrial Fibrillation ◽

Nyha Classification

Background: Catheter ablation of atrial fibrillation is an alternative treatment for patients with tachycardia-bradycardia syndrome (TBS) to avoid pacemaker implantation. The risk stratification for atrial fibrillation and outcomes between ablation and pacing has not been fully evaluated.Methods: This retrospective study involved 306 TBS patients, including 141 patients who received catheter ablation (Ablation group, age: 62.2 ± 9.0 months, mean longest pauses: 5.2 ± 2.2 s) and 165 patients who received pacemaker implement (Pacing group, age: 62.3 ± 9.1 months, mean longest pauses: 6.0 ± 2.3 s). The primary endpoint was a composite of call cause mortality, cardiovascular-related hospitalization or thrombosis events (stroke, or peripheral thrombosis). The second endpoint was progress of atrial fibrillation and heart failure.Results: After a median follow-up of 75.4 months, the primary endpoint occurred in significantly higher patients in the pacing group than in the ablation group (59.4 vs.15.6%, OR 6.05, 95% CI: 3.73–9.80, P < 0.001). None of deaths was occurred in ablation group, and 1 death occurred due to cancer. Cardiovascular-related hospitalization occurred in 50.9% of the pacing group compared with 14.2% in the ablation group (OR: 4.87, 95% CI: 2.99–7.95, P < 0.001). More thrombosis events occurred in the pacing group than in the ablation group (12.7 vs. 2.1%, OR 6.06, 95% CI: 1.81–20.35, P = 0.004). Significant more patients progressed to persistent atrial fibrillation in pacing group than in ablation group (23.6 vs. 2.1%, P < 0.001). The NYHA classification of the pacing group was significantly higher than that of the ablation group (2.11 ± 0.83 vs. 1.50 ± 0.74, P < 0.001). The proportion of antiarrhythmic drugs and anticoagulants used in the pacing group was significantly higher than that in the ablation group (41.2 vs. 7.1%, P < 0.001; 16.4 vs. 2.1%, P = 0.009).Conclusion: Catheter ablation for patients with TBS was associated with a significantly lower rate of a composite end point of cardiovascular related hospitalization and thromboembolic events. Furthermore, catheter ablation reduced the progression of atrial fibrillation and heart failure.

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