Does a Pacemaker Make a Difference? Long-Term Outcomes Post-AF Ablation in Tachy-Brady Syndrome

Area of Science:

• Cardiology
• Electrophysiology
• Medical Device Technology

Background:

• Tachy-brady syndrome (TBS) involves alternating slow and fast heart rhythms.
• Catheter ablation (CA) for atrial fibrillation (AF) is common, but outcomes in TBS patients with pacemakers are less understood.
• Permanent pacemaker (PPM) implantation is often used for bradycardia in TBS patients.

Purpose of the Study:

• To evaluate long-term outcomes of AF ablation in TBS patients stratified by PPM status.
• To compare AF recurrence, need for repeat procedures, and hospitalizations between TBS patients with and without a PPM at the time of ablation.
• To investigate the impact of delayed PPM implantation on outcomes.

Main Methods:

• Retrospective analysis of the ITHACA registry (2015-2021) including 111 TBS patients undergoing AF ablation.
• Stratification of patients based on PPM status at the time of ablation.
• Primary outcomes: composite failure (AF recurrence, cardioversion, repeat ablation) at 12 months and last follow-up, and all-cause hospitalization.

Main Results:

• Overall composite failure rates at 12 months (42% vs. 40%) and last follow-up (44% vs. 47%) were similar between patients with and without an initial PPM.
• Patients with an initial PPM had significantly higher all-cause hospitalization rates (85% vs. 62%).
• Delayed PPM implantation was associated with higher failure rates at 12 months (65%) and last follow-up (73%) and numerically higher readmissions.

Conclusions:

• Initial PPM status did not significantly impact AF ablation failure rates in TBS patients.
• Higher hospitalization rates in the initial PPM group suggest a potentially sicker patient population.
• Delayed PPM implantation was linked to worse outcomes, indicating potential benefit from earlier or concurrent PPM placement in selected TBS patients.