Long-term Clinical Outcomes of Radiofrequency Catheter Ablation versus Permanent Pacemaker Implantation in Patients with Tachycardia-Bradycardia Syndrome
- Authors
- Cho, SC[Cho, Sang Cheol]; Jin, ES[Jin, Eun-Sun]; Om, SY[Om, Sang Yong]; Hwang, KW[Hwang, Ki Won]; Choi, HO[Choi, Hyung Oh]; Kim, KH[Kim, Ki-Hun]; Kim, SH[Kim, Sung-Hwan]; Park, KM[Park, Kyoung-Min]; Kim, J[Kim, Jun]; Choi, KJ[Choi, Ki-Joon]; Kim, YH[Kim, You-Ho]; Nam, GB[Nam, Gi-Byoung]
- Issue Date
- Nov-2020
- Publisher
- KOREAN SOC CARDIOLOGY
- Keywords
- Atrial fibrillation; Catheter ablation; Pacemaker; artificial
- Citation
- KOREAN CIRCULATION JOURNAL, v.50, no.11, pp.998 - 1009
- Indexed
- SCIE
SCOPUS
KCI
- Journal Title
- KOREAN CIRCULATION JOURNAL
- Volume
- 50
- Number
- 11
- Start Page
- 998
- End Page
- 1009
- URI
- https://scholarworks.bwise.kr/skku/handle/2021.sw.skku/93634
- DOI
- 10.4070/kcj.2020.0065
- ISSN
- 1738-5520
- Abstract
- Background and Objectives: Pacemaker (PM) implantation is a well-accepted treatment option for patients with paroxysmal atrial fibrillation (AF) and related tachycardiabradycardia 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 35 +/- 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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