Background
Coexisting sick sinus syndrome (SSS) is associated with both electrical and structural
atrial remodelling in patients with atrial fibrillation (AF). Limited data are available
concerning catheter ablation (CA) for AF in this condition. This study investigated
the efficacy of CA as a curative therapy for AF and SSS in a large-scale prospective
multicentre registry.
Methods
The Kansai Plus Atrial Fibrillation (KPAF) registry enrolled 5,010 consecutive patients
who underwent CA for AF; this included 3,133 patients with paroxysmal AF (mean age,
66 years; male, 69.3%; mean CHA2DS2-VASc score, 2.05±1.50; SSS, n=315 [tachy-brady syndrome, n=285]). The endpoints included
the recurrence of AF with a blanking period of 90 days after CA, and de novo pacemaker
implantation during the follow-up period (median duration, 2.93 years).
Results
The AF-free survival did not significantly differ between patients with and those
without SSS (n=2,818) after the initial (log-rank p=0.864) and final sessions (log-rank
p=0.268). Pacemakers were implanted in 48 patients with SSS, and implantation in this
group was significantly associated with AF recurrence, including early recurrence
(adjusted odds ratio, 3.57; 95% confidence interval, 1.67–7.64; p=0.002). The remaining
85.3% of patients with SSS did not require pacemaker implantation at 3 years after
CA.
Conclusions
Coexisting SSS did not adversely affect recurrence-free survival after CA for paroxysmal
AF. Pacemaker implantation was not required in most patients with SSS, with AF recurrence
serving as a strong predictor for this.
Keywords
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Article info
Publication history
Published online: October 20, 2022
Accepted:
September 3,
2022
Received in revised form:
August 13,
2022
Received:
June 11,
2022
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
