Abstract
Sick sinus syndrome (SSS) frequently coexists with atrial fibrillation (AF). The results of AF ablation in patients with SSS have not been fully evaluated. We retrospectively investigated 65 patients with paroxysmal AF (PAF) and SSS who underwent AF ablation using either radiofrequency (n = 50) or cryoballoon ablation (n = 15) in our institute. Forty-nine (75.4%) patients had a median of 5.6 (4.8–6.0) s of documented sinus pauses prior to the procedure (42 patients on antiarrhythmic drugs), and were observed when AF terminated in 47 patients. Successful pulmonary vein isolation was achieved in all, and substrate modification was added in 3 patients. Freedom from recurrent atrial arrhythmias after single procedures was 58.7, 45.2, and 38.9% at 1, 2, and 3 years after the initial procedure. During a 23.4 (11.1–40.7) month median follow-up and after 1.4 ± 0.6 sessions, 80.6% of patients were free from arrhythmia recurrence; however, permanent pacemaker implantations were required in 9 (13.8%) patients at a median of 5.3 (2.9–21.0) months after initial procedures. The average heart rate did not significantly differ before or a median of 2.5 (1.2–5.3) months post-procedure (76.7 ± 17.4 vs. 73.5 ± 14.6 bpm, p = 0.90). Multivariate analyses revealed that larger left atrial diameters [odds ratio (OR) 1.21, 95% confidential interval (CI) 1.01–1.45, p = 0.042] were independent predictor of AF recurrence, and SSS type 1 was the sole predictor of pacemaker implantations (OR 10.30, 95% CI 1.38–76.7, p = 0.023), respectively. AF ablation obviated permanent pacemaker implantations in the majority of the patients with SSS and PAF, and SSS type 1 was a sole factor predicting pacemaker implantations.
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References
Rubenstein JJ, Schulman CL, Yurchak PM, DeSanctis RW (1972) Clinical spectrum of the sick sinus syndrome. Circulation 46:5–13
Kaplan BM, Langendorf R, Lev M, Pick A (1973) Tachycardia-bradycardia syndrome (so-called “sick sinus syndrome”): pathology, mechanisms and treatment. Am J Cardiol 31:497–508
Haïssaguerre M, Jaïs P, Shah DC, Takahashi A, Hocini M, Quiniou G, Garrigue S, Le Mouroux A, Le Métayer P, Clémenty J (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins. N Engl J Med 339:659–666
Hocini M, Sanders P, Deisenhofer I, Jaïs P, Hsu LF, Scavée C, Weerasoriya R, Raybaud F, Macle L, Shah DC, Garrigue S, Le Metayer P, Clémenty J, Haïssaguerre M (2003) Reverse remodeling of sinus node function after catheter ablation of atrial fibrillation in patients with prolonged sinus pauses. Circulation 108:1172–1175
Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot NMSN, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T (2017) 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 14:e275–e444
Miyazaki S, Kuwahara T, Kobori A, Takahashi Y, Takei A, Sato A, Isobe M, Takahashi A (2011) Long-term clinical outcome of extensive pulmonary vein isolation-based catheter ablation therapy in patients with paroxysmal and persistent atrial fibrillation. Heart 97:668–673
Miyazaki S, Taniguchi H, Kusa S, Nakamura H, Hachiya H, Hirao K, Iesaka Y (2017) Five-year follow-up outcome after catheter ablation of persistent atrial fibrillation using a sequential biatrial linear defragmentation approach: what does atrial fibrillation termination during the procedure imply? Heart Rhythm 14:34–40
Miyazaki S, Hachiya H, Nakamura H, Taniguchi H, Takagi T, Hirao K, Iesaka Y (2016) Pulmonary vein isolation using a second-generation cryoballoon in patients with paroxysmal atrial fibrillation: one-year outcome using a single big-balloon 3-minute freeze technique. J Cardiovasc Electrophysiol 27:1375–1380
Elvan A, Wylie K, Zipes DP (1996) Pacing-induced chronic atrial fibrillation impairs sinus node function in dogs. Electrophysiol Remodel Circ 94:2953–2960
Inada K, Yamane T, Tokutake K, Yokoyama K, Mishima T, Hioki M, Narui R, Ito K, Tanigawa S, Yamashita S, Tokuda M, Matsuo S, Shibayama K, Miyanaga S, Date T, Sugimoto K, Yoshimura M (2014) The role of successful catheter ablation in patients with paroxysmal atrial fibrillation and prolonged sinus pauses: outcome during a 5-year follow-up. Europace 16:208–213
Hayashi K, Fukunaga M, Yamaji K, An Y, Nagashima M, Hiroshima K, Ohe M, Makihara Y, Yamashita K, Ando K, Iwabuchi M, Goya M (2016) Impact of catheter ablation for paroxysmal atrial fibrillation in patients with sick sinus syndrome—important role of non-pulmonary vein foci. Circ J 80:887–894
Nilsson B, Chen X, Pehrson S, Hilden J, Svendsen JH (2005) Increased resting heart rate following radiofrequency catheter ablation for atrial fibrillation. Europace 7:415–420
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We thank Mr. John Martin for his help in the preparation of the manuscript.
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Hada, M., Miyazaki, S., Kajiyama, T. et al. Catheter ablation of paroxysmal atrial fibrillation in patients with sick sinus syndrome. Heart Vessels 34, 503–508 (2019). https://doi.org/10.1007/s00380-018-1256-8
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DOI: https://doi.org/10.1007/s00380-018-1256-8