Risk Stratification for Atrial Fibrillation and Outcomes in Tachycardia-Bradycardia Syndrome: Ablation vs. Pacing

Abstract

Background: Catheter ablation of atrial fibrillation is an alternative treatment for patients with tachycardia-bradycardia syndrome (TBS) to avoid pacemaker implantation. The risk stratification for atrial fibrillation and outcomes between ablation and pacing has not been fully evaluated.Methods: This retrospective study involved 306 TBS patients, including 141 patients who received catheter ablation (Ablation group, age: 62.2 ± 9.0 months, mean longest pauses: 5.2 ± 2.2 s) and 165 patients who received pacemaker implement (Pacing group, age: 62.3 ± 9.1 months, mean longest pauses: 6.0 ± 2.3 s). The primary endpoint was a composite of call cause mortality, cardiovascular-related hospitalization or thrombosis events (stroke, or peripheral thrombosis). The second endpoint was progress of atrial fibrillation and heart failure.Results: After a median follow-up of 75.4 months, the primary endpoint occurred in significantly higher patients in the pacing group than in the ablation group (59.4 vs.15.6%, OR 6.05, 95% CI: 3.73–9.80, P < 0.001). None of deaths was occurred in ablation group, and 1 death occurred due to cancer. Cardiovascular-related hospitalization occurred in 50.9% of the pacing group compared with 14.2% in the ablation group (OR: 4.87, 95% CI: 2.99–7.95, P < 0.001). More thrombosis events occurred in the pacing group than in the ablation group (12.7 vs. 2.1%, OR 6.06, 95% CI: 1.81–20.35, P = 0.004). Significant more patients progressed to persistent atrial fibrillation in pacing group than in ablation group (23.6 vs. 2.1%, P < 0.001). The NYHA classification of the pacing group was significantly higher than that of the ablation group (2.11 ± 0.83 vs. 1.50 ± 0.74, P < 0.001). The proportion of antiarrhythmic drugs and anticoagulants used in the pacing group was significantly higher than that in the ablation group (41.2 vs. 7.1%, P < 0.001; 16.4 vs. 2.1%, P = 0.009).Conclusion: Catheter ablation for patients with TBS was associated with a significantly lower rate of a composite end point of cardiovascular related hospitalization and thromboembolic events. Furthermore, catheter ablation reduced the progression of atrial fibrillation and heart failure.

Catheter ablation for treatment of bradycardia–tachycardia syndrome: is it time to consider it the therapy of choice? A systematic review and meta-analysis

“…A total of four studies, [21][22][23][24] all retrospective single centre cohorts, fulfilled all inclusion criteria (Table 1). Baseline study variables are shown in Table 2.…”

Atrial fibrillation ablation compared to pacemaker therapy in patients with tachycardia–bradycardia syndrome: A systematic review and updated meta-analysis

“…The present meta-analysis involved 5 studies [16–20] encompassing approximately 843 individuals, and revealed 4 significant findings. First, catheter ablation was found to lower the risk of stroke, and heart failure in comparison to pacemaker implantation.…”

“…Hence, a total of 5 studies, involving 843 participants, met the inclusion criteria and were used in the meta-analysis. [16][17][18][19][20] The flow diagram illustrating the process of searching and screening publications is presented in Figure 1. The characteristics of the included studies are summarized in Table 1.…”

Bayes syndrome and tachycardia-bradycardia syndrome: Consequences of atrial cardiomyopathy? Case report

“…(9) En cambio, en el STB el manejo y el tratamiento de primera línea es la implantación del marcapaso en el 30 % al 50 % de los casos, (2) pudiéndose evitar o reemplazar con ablación por catéter en más del 85 % de los pacientes con FA, evitando las infecciones o miocardiopatías provocadas por el marcapaso. (3) La ablación por catéter disminuye: la sintomatología, la tasa de mortalidad, hospitalizaciones, ACV, trombosis periférica, insuficiencia cardíaca y la conversión a FA persistente. (10) El pronóstico de la ablación por catéter; según Hada et al (11) , en 65 pacientes con 3 años de seguimiento, obtuvieron una tasa de éxito del 80,6 % en el tratamiento; igualmente Kim et al (12) en una muestra de 121 participantes con STB, demostraron que el 90,9 % no requirieron de un implante de marcapasos.…”

“…(2) La entidad clínica que incorpora un BIAa con la aparición consecutiva de taquiarritmias supraventriculares (TS), comúnmente flutter auricular o fibrilación auricular (FA), se denomina Síndrome de Bayés. (1) El STB, como parte de la ENS, se presenta como pausas sinusales significativas (mayor a 3 segundos) posterior a un evento paroxístico de taquicardia supraventricular, en especial flutter o fibrilación auricular (3) que pueden llevar al desarrollo de síncope. (2) El Síndrome de Bayés y el STB, tienen como mecanismo común al daño estructural y funcional de la aurícula izquierda (AI).…”