Catheter Ablation for Paroxysmal Atrial Fibrillation With Sick Sinus Syndrome: Insights From the Kansai Plus Atrial Fibrillation Registry - 28/02/23
, Yasunori Kanzaki, MD a, Yasuhiro Morita, MD a, Koichi Inoue, MD, PhD b, Atsushi Kobori, MD, PhD c, Kazuaki Kaitani, MD, PhD d, Toshiya Kurotobi, MD e, Hirosuke Yamaji, MD, PhD f, Yumie Matsui, MD, PhD g, Yuko Nakazawa, MD, PhD h, Kengo Kusano, MD, PhD i, Toshiro Tomomatsu, MD a, Yoshihiro Ikai, MD a, Koichi Furui, MD a, Ryota Yamauchi, MD a, Hiroyuki Miyazawa, MD a, Nobuaki Tanaka, MD b, Takeshi Morimoto, MD, PhD j, Takeshi Kimura, MD, PhD k, Satoshi Shizuta, MD, PhD kon behalf of
the KPAF Registry investigators
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.
Le texte complet de cet article est disponible en PDF.Keywords : Atrial fibrillation, Catheter ablation, Multicentre registry, Pacemaker, Sick sinus syndrome, Tachy-brady syndrome
Plan
Vol 32 - N° 2
P. 205-214 - février 2023 Retour au numéro
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