Temporal Characteristics and Management of Prolonged Sinus Pause Following Atrial Fibrillation Termination After...

Prolonged sinus pause (PSP) after atrial fibrillation (AF) termination shortly after catheter ablation seems to be a reversible phenomenon without further need for pacemaker implantation (PMI). However, no mature management strategy has been established.

In this prospective observational study, we included consecutive patients who developed PSP ≥ 3 s upon AF termination during hospitalization following AF ablation at our center between October 2020 and October 2022. Regular follow-up was conducted.

Twelve patients (mean age 66.3 ± 8.5 years; 7 females) were included. PSP ≥ 3 s upon AF termination initiated at a median of 2.0 days (IQR: 1.3-3.8) post-ablation and resolved by 5.0 days (IQR: 3.5-7.5). Three patients received temporary PMI, all of which were removed before discharge without further pacing. One patient underwent permanent PMI during hospitalization due to Adams-Stokes syndrome. After discharge, one patient received permanent pacing for symptomatic sinus arrest at 3 months, and another underwent atrioventricular node ablation followed by permanent pacing due to recurrent arrhythmia. The remaining patients had no related symptoms or need for pacing during follow-up.

PSP ≥ 3 s upon AF termination shortly after catheter ablation appears to be reversible. A watch-and-wait strategy was practical. Management may involve discontinuation of antiarrhythmic drugs or temporary pacing support. A small proportion of patients may ultimately require permanent PMI.