Acute Sinus Node Dysfunction after Atrial Ablation: Incidence, Risk Factors, and Management

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Concomitant sinus node dysfunction (SND) is common in patients with atrial fibrillation (AF) or atrial flutter (Aflutter).
• Atrial ablation procedures carry a risk of injuring the sinus node complex or its blood supply, potentially leading to sinus arrest and the need for pacing.

Purpose of the Study:

• To characterize patients who develop acute sinus node dysfunction (ASND) during or immediately after AF/Aflutter ablation.
• To identify risk factors and outcomes associated with ASND following atrial ablation.

Main Methods:

• Retrospective analysis of 2,151 patients undergoing AF/Aflutter ablation between January 1, 2010, and February 28, 2015.
• Identification of patients requiring temporary pacemaker (TPM) implantation due to ASND (sinus arrest, severe sinus bradycardia, or hemodynamically compromising junctional rhythm).

Main Results:

• Eight patients (<0.5%) developed ASND, manifesting as sinus arrest, severe sinus bradycardia, or junctional rhythm.
• Patients undergoing ablation near the superior vena cava (SVC) were significantly more likely to develop ASND (P = 0.03).
• Six of the eight patients required permanent pacemaker implantation before discharge.

Conclusions:

• Acute sinus node dysfunction is a rare but significant complication of atrial ablation.
• Peri-SVC ablation may be associated with a higher risk of ASND.
• ASND following atrial ablation may necessitate permanent pacemaker implantation.