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Heart and Vessels

, Volume 34, Issue 3, pp 503–508 | Cite as

Catheter ablation of paroxysmal atrial fibrillation in patients with sick sinus syndrome

  • Masahiro Hada
  • Shinsuke MiyazakiEmail author
  • Takatsugu Kajiyama
  • Masao Yamaguchi
  • Shigeki Kusa
  • Hiroaki Nakamura
  • Hitoshi Hachiya
  • Hiroshi Tada
  • Kenzo Hirao
  • Yoshito Iesaka
Original Article
  • 129 Downloads

Abstract

Sick sinus syndrome (SSS) frequently coexists with atrial fibrillation (AF). The results of AF ablation in patients with SSS have not been fully evaluated. We retrospectively investigated 65 patients with paroxysmal AF (PAF) and SSS who underwent AF ablation using either radiofrequency (n = 50) or cryoballoon ablation (n = 15) in our institute. Forty-nine (75.4%) patients had a median of 5.6 (4.8–6.0) s of documented sinus pauses prior to the procedure (42 patients on antiarrhythmic drugs), and were observed when AF terminated in 47 patients. Successful pulmonary vein isolation was achieved in all, and substrate modification was added in 3 patients. Freedom from recurrent atrial arrhythmias after single procedures was 58.7, 45.2, and 38.9% at 1, 2, and 3 years after the initial procedure. During a 23.4 (11.1–40.7) month median follow-up and after 1.4 ± 0.6 sessions, 80.6% of patients were free from arrhythmia recurrence; however, permanent pacemaker implantations were required in 9 (13.8%) patients at a median of 5.3 (2.9–21.0) months after initial procedures. The average heart rate did not significantly differ before or a median of 2.5 (1.2–5.3) months post-procedure (76.7 ± 17.4 vs. 73.5 ± 14.6 bpm, p = 0.90). Multivariate analyses revealed that larger left atrial diameters [odds ratio (OR) 1.21, 95% confidential interval (CI) 1.01–1.45, p = 0.042] were independent predictor of AF recurrence, and SSS type 1 was the sole predictor of pacemaker implantations (OR 10.30, 95% CI 1.38–76.7, p = 0.023), respectively. AF ablation obviated permanent pacemaker implantations in the majority of the patients with SSS and PAF, and SSS type 1 was a sole factor predicting pacemaker implantations.

Keywords

Sick sinus syndrome Pulmonary vein isolation Atrial fibrillation Catheter ablation Pacemaker 

Notes

Acknowledgements

We thank Mr. John Martin for his help in the preparation of the manuscript.

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Masahiro Hada
    • 1
  • Shinsuke Miyazaki
    • 1
    • 2
    Email author
  • Takatsugu Kajiyama
    • 1
  • Masao Yamaguchi
    • 1
  • Shigeki Kusa
    • 1
  • Hiroaki Nakamura
    • 1
  • Hitoshi Hachiya
    • 1
  • Hiroshi Tada
    • 1
    • 2
  • Kenzo Hirao
    • 1
    • 3
  • Yoshito Iesaka
    • 1
  1. 1.Cardiovascular Center, Tsuchiura Kyodo HospitalTsuchiuraJapan
  2. 2.Department of Cardiovascular MedicineFukui UniversityYoshidaJapan
  3. 3.Heart Rhythm CenterTokyo Medical and Dental UniversityTokyoJapan

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