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Pacemaker implantation after catheter ablation for atrial fibrillation

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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.

Methods and 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).

Conclusion

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.

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Authors and Affiliations

  1. Cardiovascular Diseases, Mayo Clinic Heart Rhythm Section, Rochester, MN, USA

    Abhishek J. Deshmukh, Samuel J. Asirvatham, Paul A. Friedman, Douglas L. Packer & Peter A. Noseworthy

  2. Mayo Clinic Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Rochester, MN, USA

    Xiaoxi Yao, Stephanie Schilz, Holly Van Houten & Lindsey R. Sangaralingham

  3. Optum Labs, Cambridge, MA, USA

    Xiaoxi Yao

  4. Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, 55902, USA

    Peter A. Noseworthy

Authors
  1. Abhishek J. Deshmukh
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  2. Xiaoxi Yao
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  3. Stephanie Schilz
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  4. Holly Van Houten
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  5. Lindsey R. Sangaralingham
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  6. Samuel J. Asirvatham
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  7. Paul A. Friedman
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  8. Douglas L. Packer
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  9. Peter A. Noseworthy
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Corresponding author

Correspondence to Peter A. Noseworthy.

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Funding sources

This study was funded by the Mayo Clinic Robert D and Patricia E Kern Center for the Science of Health Care Delivery.

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Deshmukh, A.J., Yao, X., Schilz, S. et al. Pacemaker implantation after catheter ablation for atrial fibrillation. J Interv Card Electrophysiol 45, 99–105 (2016). https://doi.org/10.1007/s10840-015-0071-8

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  • DOI: https://doi.org/10.1007/s10840-015-0071-8

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