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Kataoka N, Imamura T. How to compare clinical benefit between catheter ablation versus anti-arrhythmic drug to treat sinus node dysfunction and atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01840-9. [PMID: 39017964 DOI: 10.1007/s10840-024-01840-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 07/18/2024]
Affiliation(s)
- Naoya Kataoka
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
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Su L, Wang X, Kang F, Gong C, Chen D. Atrial fibrillation ablation compared to pacemaker therapy in patients with tachycardia-bradycardia syndrome: A systematic review and updated meta-analysis. Medicine (Baltimore) 2024; 103:e37543. [PMID: 38640303 PMCID: PMC11030008 DOI: 10.1097/md.0000000000037543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Tachycardia-bradycardia syndrome (TBS) is a subtype of sick sinus syndrome characterized by prolonged sinus pause (≥3 s) following termination of tachyarrhythmias, primarily atrial fibrillation (AF). There is controversy regarding whether the long-term prognosis of AF ablation is superior to pacemaker implantation. This study aimed to compare the effects of AF ablation and pacemaker therapy in patients with TBS. METHODS We conducted a comprehensive search of electronic databases, including PubMed, Cochrane, EmBase, Web of Science, and Chinese BioMedical, up until December 1, 2023. We included studies that reported the effects of AF ablation vs pacemaker therapy in patients with TBS. From this search, we identified 5 studies comprising 843 participants with TBS who underwent catheter AF ablation or pacemaker therapy. RESULTS Our meta-analysis revealed that AF ablation and pacemaker therapy had similar effects on cardiovascular death (odds ratio [OR] = 0.62 and 95% confidence interval [CI]: 0.14-2.65), procedural complications (OR = 1.53 and 95% CI: 0.67-3.48), and cardiovascular rehospitalization (OR = 0.57 and 95% CI: 0.26-1.22). However, AF ablation provided greater benefits than pacemaker therapy in terms of all-cause mortality (OR = 0.37 and 95% CI: 0.17-0.82), thromboembolism (OR = 0.25 and 95% CI: 0.12-0.49), stroke (OR = 0.28 and 95% CI: 0.13-0.57), heart failure (OR = 0.27 and 95% CI: 0.13-0.56), freedom from AF (OR = 23.32 and 95% CI: 7.46-72.92), and prevention of progression to persistent AF (OR = 0.12 and 95% CI: 0.06-0.24). Furthermore, AF ablation resulted in a reduced need for antiarrhythmic agents (OR = 0.21 and 95% CI: 0.08-0.59). CONCLUSION AF ablation can effectively reduce the risk of all-cause mortality, thromboembolism, stroke, heart failure, and progression to persistent AF in patients with TBS. Additionally, it may eliminate the need for further pacemaker therapy in most cases after ablation. Therefore, AF ablation is considered superior to pacemaker therapy in the management of patients with TBS.
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Affiliation(s)
- Lijun Su
- Department of Rehabilitation, ShunDe Hospital of Guangzhou University of Chinese Medicine, Foshan, China
| | - Xiaoqi Wang
- Department of Emergency, ShunDe Hospital of Guangzhou University of Chinese Medicine, Foshan, China
| | - Fengguang Kang
- Department of Emergency, ShunDe Hospital of Guangzhou University of Chinese Medicine, Foshan, China
| | - Caidi Gong
- Department of Emergency, ShunDe Hospital of Guangzhou University of Chinese Medicine, Foshan, China
| | - Dezhu Chen
- Department of Emergency and Critical Care Medicine, ShunDe Hospital of Guangzhou University of Chinese Medicine, Foshan, China
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Arai T, Iwasaki YK, Hayashi H, Ito N, Hachisuka M, Kobayashi S, Fujimoto Y, Hagiwara K, Murata H, Yodogawa K, Shimizu W, Asai K. Enlarged right atrium predicts pacemaker implantation after atrial fibrillation ablation in patients with tachycardia-bradycardia syndrome. IJC HEART & VASCULATURE 2023; 49:101297. [PMID: 38035257 PMCID: PMC10682653 DOI: 10.1016/j.ijcha.2023.101297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/16/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023]
Abstract
Introduction Although catheter ablation (CA) of tachycardia-bradycardia syndrome (TBS) in patients with atrial fibrillation (AF) is considered to be an effective treatment strategy, pacemaker implantations (PMIs) are often required even after a successful CA. This study aimed to elucidate the clinical predictors of a PMI after CA. Methods From 2011 to 2020, 103 consecutive patients diagnosed with TBS were retrospectively enrolled in the study. Among the 103 patients, 54 underwent a PMI and 49 CA of AF. During 47.4 ± 35.4 months after 1.4 ± 0.6 CA sessions, 37 (75.5%) of 49 patients were free from atrial arrhythmia recurrences. PMIs were performed in 11 patients (PMI group) and the remaining 38 did not receive a PMI (non-PMI group). Results When comparing the PMI and non-PMI groups, there were no differences in the basic mean heart rate (P = 0.36), maximum pauses detected by 24-hour Holter-monitoring (P = 0.61), and other clinical parameters between the two groups while the right atrial area index was larger (42.1 ± 24.0 vs. 21.8 ± 8.4 cm2/m2 P = 0.002) in the PMI group than non-PMI group. The ROC curve analysis showed that the optimal cutoff point of the ratio of the right atrial area index to the left atrial area index for predicting a PMI following CA was 0.812 (Sensitivity 72.7%, specificity 71.1%, positive predictive value 42.1%, negative predictive value 90.0%, diagnostic accuracy 71.4%, AUC = 0.81). Conclusion Right atrial enlargement prior to CA was considered to be one of the risk factors for a PMI after CA of AF.
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Affiliation(s)
- Toshiki Arai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yu-ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroshi Hayashi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Nobuaki Ito
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Masato Hachisuka
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Serina Kobayashi
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yuhi Fujimoto
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kanako Hagiwara
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroshige Murata
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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Liu Y, Zheng Y, Tse G, Bazoukis G, Letsas K, Goudis C, Korantzopoulos P, Li G, Liu T. Association between sick sinus syndrome and atrial fibrillation: A systematic review and meta-analysis. Int J Cardiol 2023; 381:20-36. [PMID: 37023861 DOI: 10.1016/j.ijcard.2023.03.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/17/2023] [Accepted: 03/31/2023] [Indexed: 04/08/2023]
Abstract
AIMS Sick sinus syndrome (SSS) and atrial fibrillation (AF) frequently coexist and show a bidirectional relationship. This systematic review and meta-analysis aimed to decipher the precise relationship between SSS and AF, further exploring and comparing different therapy strategies on the occurrence or progression of AF in patients with SSS. METHODS AND RESULTS A systematic literature search was conducted until November 2022. A total of 35 articles with 37,550 patients were included. Patients with SSS were associated with new-onset AF compared to those without SSS. Catheter ablation was associated with a lower risk of AF recurrence, AF progression, all-cause mortality, stroke and hospitalization of heart failure compared to pacemaker therapy. Regarding the different pacing strategies for SSS, VVI/VVIR has higher risk of new-onset AF than DDD/DDDR. No significant difference was found between AAI/AAIR and DDD/DDDR, as well as between DDD/DDDR and minimal ventricular pacing (MVP) for AF recurrence. AAI/AAIR was associated with higher risk of all-cause mortality when compared to DDD/DDDR, but lower risk of cardiac death when compared to DDD/DDDR. Right atrial septum pacing was associated with a similar risk of new-onset AF or AF recurrence compared to right atrial appendage pacing. CONCLUSION SSS is associated with a higher risk of AF. For patients with both SSS and AF, catheter ablation should be considered. This meta-analysis re-emphasizes that high percentage of ventricular pacing should be avoided in patients with SSS in order to decrease AF burden and mortality.
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Affiliation(s)
- Ying Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Yi Zheng
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China; Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, Kent, UK; School of Nursing and Health Studies, Hong Kong, Metropolitan University, Hong Kong, China
| | - George Bazoukis
- Department of Cardiology, Larnaca General Hospital, Inomenon Polition Amerikis, Larnaca, Cyprus; Department of Basic and Clinical Sciences, University of Nicosia Medical School, 2414 Nicosia, Cyprus
| | - Konstantinos Letsas
- Laboratory of Cardiac Electrophysiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Christos Goudis
- Department of Cardiology, Serres General Hospital, 45110 Serres, Greece
| | | | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China.
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Morishima I, Kanzaki Y, Morita Y, Inoue K, Kobori A, Kaitani K, Kurotobi T, Yamaji H, Matsui Y, Nakazawa Y, Kusano K, Tomomatsu T, Ikai Y, Furui K, Yamauchi R, Miyazawa H, Tanaka N, Morimoto T, Kimura T, Shizuta S. Catheter Ablation for Paroxysmal Atrial Fibrillation With Sick Sinus Syndrome: Insights From the Kansai Plus Atrial Fibrillation Registry. Heart Lung Circ 2023; 32:205-214. [PMID: 36274004 DOI: 10.1016/j.hlc.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/13/2022] [Accepted: 09/03/2022] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
| | - Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Koichi Inoue
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Atsushi Kobori
- Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazuaki Kaitani
- Division of Cardiology, Otsu Red Cross Hospital, Otsu, Japan
| | - Toshiya Kurotobi
- Cardiovascular Center, Nanba Kurotobi Heart Clinic, Osaka, Japan
| | | | - Yumie Matsui
- Department of Cardiology, Saiseikai Izuo Hospital, Osaka, Japan
| | - Yuko Nakazawa
- Department of Cardiovascular Medicine, Heart Rhythm Center, Shiga University of Medical Science, Shiga, Japan
| | - Kengo Kusano
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | | | - Yoshihiro Ikai
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Koichi Furui
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Ryota Yamauchi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | | | - Nobuaki Tanaka
- Cardiovascular Center, Sakurabashi-Watanabe Hospital, Osaka, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Tokuda M, Yamashita S, Hachisuka E, Sato H, Oseto H, Yokoyama M, Tokutake K, Yokoyama K, Kato M, Narui R, Tanigawa SI, Yoshimura M, Yamane T. A 15-year follow-up study of Radiofrequency Catheter Ablation for Atrial Fibrillation in Patients with Tachycardia-Bradycardia Syndrome. J Cardiovasc Electrophysiol 2022; 33:2100-2103. [PMID: 35842800 DOI: 10.1111/jce.15628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/29/2022] [Accepted: 07/09/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Catheter ablation for atrial fibrillation (AF) in patients with tachycardia-bradycardia syndrome (TBS) can be major therapeutic option to replace permanent pacemaker implantation (PMI). However, the very long-term outcome more than 15 years in these patients has not been elucidated. METHODS From 2002 to 2008, 25 consecutive TBS patients (62 ± 7.9 years old, 68% male) with both AF and symptomatic sinus pauses (>3.0 sec) were performed radiofrequency AF ablation. These patients were followed for 15 ± 2.7 years. RESULTS The median longest sinus pause before ablation procedure was 6.0 (4.4-8.0) seconds. Following 1.6±0.8 ablation procedures, 18(72%) patients remained free from AF. Three (12%) patients died due to non-cardiovascular causes, and 7(28%) patients underwent PMI due to symptomatic sinus pause after recurrent AF in 5 patients and progression of sinus node dysfunction in 2 patients. The median duration from the first AF ablation to PMI was 6.3 years (range 9 days to 11.0 years). Five and 2 patients required PMI more than 5 and 10 years after the first ablation procedure, respectively. CONCLUSIONS AF ablation prevented PMI in the 72% of TBS patients for 15 years follow up. However, in consideration of long duration to PMI, a continuous careful long-term follow-up was warranted. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Michifumi Tokuda
- Department of Cardiology, The Jikei University School of Medicine
| | - Seigo Yamashita
- Department of Cardiology, The Jikei University School of Medicine
| | - Eri Hachisuka
- Department of Cardiology, The Jikei University School of Medicine
| | - Hidenori Sato
- Department of Cardiology, The Jikei University School of Medicine
| | - Hirotsuna Oseto
- Department of Cardiology, The Jikei University School of Medicine
| | - Masaaki Yokoyama
- Department of Cardiology, The Jikei University School of Medicine
| | - Kenichi Tokutake
- Department of Cardiology, The Jikei University School of Medicine
| | - Kenichi Yokoyama
- Department of Cardiology, The Jikei University School of Medicine
| | - Mika Kato
- Department of Cardiology, The Jikei University School of Medicine
| | - Ryohsuke Narui
- Department of Cardiology, The Jikei University School of Medicine
| | | | | | - Teiichi Yamane
- Department of Cardiology, The Jikei University School of Medicine
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Sinus Node Dysfunction after Successful Atrial Flutter Ablation during Follow-Up: Clinical Characteristics and Predictors. J Clin Med 2022; 11:jcm11113212. [PMID: 35683600 PMCID: PMC9181344 DOI: 10.3390/jcm11113212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 12/04/2022] Open
Abstract
Identification of sinus node dysfunction (SND) before termination of persistent AFL by catheter ablation (CA) is challenging. This study aimed to investigate the characteristics and predictors of acute and delayed SND after AFL ablation. We retrospectively enrolled 221 patients undergoing CA of persistent AFL in a tertiary referral center. Patients with SND who required a temporary pacemaker (TPM) after termination of AFL or a permanent pacemaker (PPM) during follow-up were identified. Acute SND requiring a TPM was found in 14 of 221 (6.3%) patients following successful termination of AFL. A total of 10 of the 14 patients (71.4%) recovered from acute SND. An additional 11 (5%) patients presenting with delayed SND required a PPM during follow-up, including 4 patients recovering from acute SND. Of these, 9 of these 11 patients (81.8%) underwent PPM implantation within 1 year after the ablation. In multivariable analysis, female gender and a history of hypothyroidism were associated with the requirement for a TPM following termination of persistent AFL, while older age and a history of hypothyroidism predicted PPM implantation. This study concluded that the majority of patients with acute SND still require a PPM implantation despite the initial improvement. Therefore, it is reasonable to monitor the patients closely for at least one year after AFL ablation.
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Predictors of permanent pacemaker implantation after sinus conversion of cavotricuspid isthmus-dependent atrial flutter. Sci Rep 2022; 12:5336. [PMID: 35351981 PMCID: PMC8964688 DOI: 10.1038/s41598-022-09439-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/22/2022] [Indexed: 12/21/2022] Open
Abstract
It is unclear which factors are associated with progressive sinus node dysfunction after cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) ablation. We sought to evaluate the incidence and predictors for permanent pacemaker (PPM) implantation after CTI-dependent AFL ablation. Between January 2011 and June 2021, 353 patients underwent CTI-dependent AFL ablation were studied. During a median follow-up of 31.6 months, 30 patients (8.5%) received PPM implantation, 24 for sick sinus syndrome and 6 for atrioventricular block. In multivariable model, prior atrial fibrillation (AF) (HR 3.570; 95% CI 1.034–12.325; P = 0.044), lowest previous sinus heart rate (HR 0.942; 95% CI 0.898–0.988; P = 0.015), and left atrial volume index (LAVI) (HR 1.067; 95% CI 1.024–1.112; P = 0.002) were independently associated with PPM implantation after CTI-dependent AFL ablation. The best cut-off points for predicting PPM implantation were 60.1 ml/m2 for LAVI and 46 beats per minute for lowest previous sinus heart rate. Among the patients discharged without PPM implantation after ablation, sinus pause over three seconds at AFL termination during ablation was an independent predictor of PPM implantation (HR 17.841; 95% CI 4.626–68.807; P < 0.001). Physicians should be aware of the possibility of PPM implantation during follow-up after AFL ablation, especially in patients with the relevant risk factors.
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Chang W, Li G. Clinical review of sick sinus syndrome and atrial fibrillation. Herz 2021; 47:244-250. [PMID: 34156514 DOI: 10.1007/s00059-021-05046-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 12/25/2022]
Abstract
Sick sinus syndrome (SSS) is a set of diseases with abnormal cardiac pacing, which manifests as diverse cardiac arrhythmias, especially bradycardia. The clinical presentation is inconspicuous in the early stage, but with the progression of this disease, patients may present with symptoms and signs of end-organ hypoperfusion. As a common result in the natural history of the disease, SSS coexisting with atrial fibrillation (AF) forms the basis of bradycardia-tachycardia syndrome. Age-related interstitial fibrosis is considered to be the common pathophysiological mechanism between SSS and AF. The combination of these diseases will adversely affect the condition of patients and the efficiency of subsequent treatment. Although the exact mechanism is not clear to date, the extensive structural and electrical remodeling of the atrium are considered to be the important mechanism for the occurrence of AF in patients with SSS. Pacemaker implantation is the first-line treatment for symptomatic patients with SSS and documented bradycardia history. In view of the adverse effects of AF on the treatment of SSS, researchers have focused on evaluating different pacing modes and algorithms to reduce the risk of AF during pacing. Catheter ablation may also be used as an alternative second-line therapy for some patients with SSS and AF.
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Affiliation(s)
- Wenxing Chang
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical University, 116027, Dalian, China
| | - Guangsen Li
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical University, 116027, Dalian, China.
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Zhang R, Wang Y, Yang M, Yang Y, Wang Z, Yin X, Dong Y, Yu X, Xiao X, Gao L, Xia Y. Risk Stratification for Atrial Fibrillation and Outcomes in Tachycardia-Bradycardia Syndrome: Ablation vs. Pacing. Front Cardiovasc Med 2021; 8:674471. [PMID: 34169100 PMCID: PMC8217458 DOI: 10.3389/fcvm.2021.674471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/06/2021] [Indexed: 01/11/2023] Open
Abstract
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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Affiliation(s)
- Rongfeng Zhang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yue Wang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Minghui Yang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yiheng Yang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhengyan Wang
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaomeng Yin
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yingxue Dong
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaohong Yu
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xianjie Xiao
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lianjun Gao
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
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11
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Shim J. Management of Tachycarida-bradycardia Syndrome: To Pace or to Ablate, That Is the Question. Korean Circ J 2020; 50:1010-1012. [PMID: 33118334 PMCID: PMC7596216 DOI: 10.4070/kcj.2020.0363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/31/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea.
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Zhang S, Yang Y, Xia Y, Gao L, Zhang X, Tse G, Yin X, Dai S, Chang D. Long-term effect of catheter ablation on tachycardia-bradycardia syndrome: evidenced by 10 years follow up. Acta Cardiol 2020; 75:537-543. [PMID: 31251116 DOI: 10.1080/00015385.2019.1630055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Catheter ablation has been used for the treatment of tachycardia-bradycardia syndrome (TBS). However, data on its long-term effect of rhythm control and stroke are limited.Method and results: Patients with TBS admitted in the First Affiliated Hospital of Dalian Medical University from 2002 to 2013 were reviewed in the present study. A total of 150 patients were enrolled. Seventy-nine patients underwent catheter ablation (CA group) and 71 patients chose implantation of pacemaker (PM group). The two groups were followed up for 123.01 ± 29.68 and 120.67 ± 31.05 months respectively. The CA group underwent 1.2 ± 0.5 procedure. Of the CA group, 70.9% patients exhibited sinus rhythm without long pauses or the need of anti-arrhythmia drugs (AADs). In contrast, no patient in the PM group was free of atrial fibrillation (AF). A higher proportion in the PM group progressed to persistent AF than in that in the CA group (9.9% vs. 1.3%, p < .05). The incidence of new-onset stroke in the PM group was significantly higher than that in the CA group (15.4% vs. 5.1%, p < .05).Conclusions: Even for long-term following up, catheter ablation is effective for preventing both the tachycardia and bradycardia components for the majority of patients with TBS without the need for further pacemaker implantation. Furthermore, ablation can reduce the stroke incidence of TBS through eliminating AF and reducing the progression to persistent AF.
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Affiliation(s)
- Shushan Zhang
- The Fifth Affiliated Hospital of Zhongshan Medical University, China
| | - Yanzong Yang
- First Affiliated Hospital of Dalian Medical University, China
| | - Yunlong Xia
- First Affiliated Hospital of Dalian Medical University, China
| | - Lianjun Gao
- First Affiliated Hospital of Dalian Medical University, China
| | - Xuanhe Zhang
- Zhuhai Maternal and Child Health Care Hospital, China
| | - Gary Tse
- Chinese University of Hong Kong, Hong Kong, China
| | - Xiaomeng Yin
- First Affiliated Hospital of Dalian Medical University, China
| | - Shiyu Dai
- First Affiliated Hospital of Dalian Medical University, China
| | - Dong Chang
- First Affiliated Hospital of Dalian Medical University, China
- Xiamen Cardiovascular Hospital, Xiamen University, China
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Cho SC, Jin ES, Om SY, Hwang KW, Choi HO, Kim KH, Kim SH, Park KM, Kim J, Choi KJ, Kim YH, Nam GB. Long-term Clinical Outcomes of Radiofrequency Catheter Ablation versus Permanent Pacemaker Implantation in Patients with Tachycardia-Bradycardia Syndrome. Korean Circ J 2020; 50:998-1009. [PMID: 32812404 PMCID: PMC7596208 DOI: 10.4070/kcj.2020.0065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/02/2020] [Accepted: 06/26/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pacemaker (PM) implantation is a well-accepted treatment option for patients with paroxysmal atrial fibrillation (AF) and related tachycardia-bradycardia syndrome (TBS). Data on the long-term clinical outcomes after radiofrequency catheter ablation (RFCA) or PM implantation are sparse. METHODS The medical records of 217 patients with TBS were retrospectively assessed. Outcomes in patients who underwent RFCA (n=108, 49.8%) were compared to those with PM implantation (n=109, 50.2%). The clinical outcomes were sinus rhythm maintenance, conversion to persistent AF, additional procedure or crossover, and the composite of cardiovascular hospitalization and death. RESULTS During the follow-up period (mean 3.5±2.0 years), the RFCA group, compared to the PM group, showed better sinus rhythm maintenance (adjusted hazard ratio [aHR], 0.27; 95% confidence interval [CI], 0.15-0.46; p=0.002) and less progression to persistent AF (aHR, 0.20; 95% CI, 0.06-0.63; p=0.006). Additional procedure or crossover did not differ significantly between the groups (aHR, 2.07; 95% CI, 0.71-6.06; p=0.185 and aHR, 0.69; 95% CI, 10.8-2.67; p=0.590, respectively). Most RFCA patients (92.6%) did not require pacemaker implantation during long term follow-up period (>3.5 years). The composite endpoint of cardiovascular rehospitalization and death was not significantly different between the groups (aHR, 0.92; 95% CI, 0.50-1.66; p=0.769). CONCLUSIONS RFCA is an effective alternative to PM implantation in patients with TBS. In these patients, successful RF ablation of AF is related to a higher rate of sinus rhythm maintenance compared to PM implantation, and the composite outcome of cardiovascular rehospitalization and death is similar.
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Affiliation(s)
- Sang Cheol Cho
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eun Sun Jin
- Cardiovascular Center, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang Yong Om
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ki Won Hwang
- Division of Cardiology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University of Medicine, Yangsan, Korea
| | - Hyung Oh Choi
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ki Hun Kim
- Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung Hwan Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung Min Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Jun Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ki Joon Choi
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - You Ho Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Gi Byoung Nam
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Park SJ. Catheter Ablation is Effective for Recovery from Sinus Node Dysfunction in Patients with Atrial Fibrillation, But Close Monitoring is Still Needed. Korean Circ J 2020; 50:358-360. [PMID: 32157833 PMCID: PMC7067611 DOI: 10.4070/kcj.2020.0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 02/03/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Seung Jung Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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