Pacing or ablation: which is better for paroxysmal atrial fibrillation-related tachycardia-bradycardia syndrome?

CHEN, YING‐WEI; BAI, RONG; LIN, TAO; SALIM, MOHAMED; SANG, CAI‐HUA; LONG, DE‐YONG; YU, RONG‐HUI; TANG, RI‐BO; GUO, XUE‐YUAN; YAN, XIAN‐LIANG; NIE, JUN‐GANG; DU, XIN; DONG, JIAN‐ZENG; MA, CHANG‐SHENG

doi:10.1111/pace.12340

Cited by 81Atrial Fibrillation Management and OutcomesCardiac pacing and defibrillation studiesCardiac Arrhythmias and Treatments

Pacing or ablation: which is better for paroxysmal atrial fibrillation-related tachycardia-bradycardia syndrome?

CHEN, YING‐WEI, BAI, RONG, LIN, TAO, SALIM, MOHAMED, SANG, CAI‐HUA, LONG, DE‐YONG, YU, RONG‐HUI, TANG, RI‐BO +6 more·2014·Pacing and Clinical Electrophysiology

DOI 10.1111/pace.12340

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Abstract

BACKGROUND: Symptomatic prolonged sinus pauses on termination of atrial fibrillation (AF) are an accepted indication for pacemaker implantation. We evaluated the outcome of AF ablation in patients with paroxysmal AF-related tachycardia-bradycardia syndrome and compared the efficacy of catheter ablation with permanent pacing plus antiarrhythmic drugs (AADs). METHODS AND RESULTS: Patients with prolonged symptomatic sinus pauses on termination of AF were retrospectively analyzed. Forty-three consecutive patients who underwent catheter ablation (ABL group) were compared to 57 patients who underwent permanent pacing plus AADs (PM group). All 43 patients in the ABL group fulfilled Class I indication for pacemaker implantation at baseline but they actually underwent AF ablation. Reevaluation after 20.1 ± 9.6 months of follow-up showed that 41 patients (95.3%) did no longer need a pacemaker (Class III indication). Total cardiac-related rehospitalization was not significantly different between the two groups (P = 0.921). Tachycardia-related hospitalization was significantly higher in the PM group than the ABL group (14.0% and 0%, P = 0.029). More patients in the PM group were on AADs (PM 40.4%, ABL 4.7%, P < 0.001) while sinus rhythm maintenance was remarkably higher in the ABL group at the end of follow-up (83.7% vs 21.1% in PM group, P < 0.001). CONCLUSIONS: In patients with paroxysmal AF-related tachycardia-bradycardia syndrome, AF ablation seems to be superior to a strategy of pacing plus AAD. Pacemaker implantation can be waived in the majority of patients after a successful ablation.

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Some patients with AF-induced bradycardia may benefit from catheter ablation of AF, obviating the need for antiarrhythmic drugs and pacemaker implantation.
“Some patients with AF-induced bradycardia may benefit from catheter ablation of AF, obviating the need for antiarrhythmic drugs and pacemaker implantation.829,830”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [829]

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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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Authors: CHEN, Y., BAI, R., LIN, T., SALIM, M., SANG, C., LONG, D., YU, R., TANG, R., GUO, X., YAN, X., NIE, J., DU, X., DONG, J., & MA, C.
Affiliations: Capital Medical University (CN)
Department of Cardiology Beijing An Zhen Hospital Capital Medical University Beijing China
ORCID: BAI, RONG
LIN, TAO
DU, XIN
Venue: Pacing and Clinical Electrophysiology
Publisher: Wiley
Published: 2014-01-23
Volume: 37
Issue: 4
Pages: 403-411
ISSN: 0147-8389 (ISSN-L)
1540-8159
DOI: 10.1111/pace.12340
OpenAlex: W1538469409
Cited by: 81
References: 28
Citations by year: 2026: 4 · 2025: 4 · 2024: 13 · 2023: 5 · 2022: 9 · 2021: 8 · 2020: 5 · 2019: 6 · 2018: 8 · 2017: 10 · 2016: 5 · 2015: 2 · 2014: 2
FWCI: 4.34
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Pacing and Clinical Electrophysiology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Keywords: paroxysmal atrial fibrillation, bradycardia-tachycardia syndrome, catheter ablation, permanent cardiac pacing, antiarrhythmic drugs, sinus pause, sinus rhythm maintenance, pacemaker implantation
MeSH terms: Aged, Anti-Arrhythmia Agents, Atrial Fibrillation, Cardiac Pacing, Artificial, China, Combined Modality Therapy, Female, Hospitalization, Humans, Male, Middle Aged, Retrospective Studies, Sick Sinus Syndrome, Survival Rate, Treatment Outcome

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Pacing or ablation: which is better for paroxysmal atrial fibrillation-related tachycardia-bradycardia syndrome?

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