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Pacing or Ablation: Which Is Better for Paroxysmal Atrial Fibrillation-Related Tachycardia-Bradycardia Syndrome?
- Source :
- Pacing & Clinical Electrophysiology; Apr2014, Vol. 37 Issue 4, p403-411, 9p
- Publication Year :
- 2014
-
Abstract
- Background Symptomatic prolonged sinus pauses on termination of atrial fibrillation (AF) are an accepted indication for pacemaker implantation. We evaluated the outcome of AF ablation in patients with paroxysmal AF-related tachycardia-bradycardia syndrome and compared the efficacy of catheter ablation with permanent pacing plus antiarrhythmic drugs (AADs). Methods and Results Patients with prolonged symptomatic sinus pauses on termination of AF were retrospectively analyzed. Forty-three consecutive patients who underwent catheter ablation (ABL group) were compared to 57 patients who underwent permanent pacing plus AADs (PM group). All 43 patients in the ABL group fulfilled Class I indication for pacemaker implantation at baseline but they actually underwent AF ablation. Reevaluation after 20.1 ± 9.6 months of follow-up showed that 41 patients (95.3%) did no longer need a pacemaker (Class III indication). Total cardiac-related rehospitalization was not significantly different between the two groups (P = 0.921). Tachycardia-related hospitalization was significantly higher in the PM group than the ABL group (14.0% and 0%, P = 0.029). More patients in the PM group were on AADs (PM 40.4%, ABL 4.7%, P < 0.001) while sinus rhythm maintenance was remarkably higher in the ABL group at the end of follow-up (83.7% vs 21.1% in PM group, P < 0.001). Conclusions In patients with paroxysmal AF-related tachycardia-bradycardia syndrome, AF ablation seems to be superior to a strategy of pacing plus AAD. Pacemaker implantation can be waived in the majority of patients after a successful ablation. [ABSTRACT FROM AUTHOR]
- Subjects :
- MYOCARDIAL depressants
CARDIAC pacemakers
ATRIAL fibrillation
BRADYCARDIA
CATHETER ablation
CHI-squared test
FISHER exact test
LONGITUDINAL method
HEALTH outcome assessment
T-test (Statistics)
TACHYCARDIA
TREATMENT effectiveness
DATA analysis software
DESCRIPTIVE statistics
KAPLAN-Meier estimator
LOG-rank test
DISEASE complications
THERAPEUTICS
Subjects
Details
- Language :
- English
- ISSN :
- 01478389
- Volume :
- 37
- Issue :
- 4
- Database :
- Complementary Index
- Journal :
- Pacing & Clinical Electrophysiology
- Publication Type :
- Academic Journal
- Accession number :
- 95465617
- Full Text :
- https://doi.org/10.1111/pace.12340