Predictors of permanent pacemaker implantation after sinus conversion of cavotricuspid isthmus-dependent atrial flutter

Abstract

It is unclear which factors are associated with progressive sinus node dysfunction after cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) ablation. We sought to evaluate the incidence and predictors for permanent pacemaker (PPM) implantation after CTI-dependent AFL ablation. Between January 2011 and June 2021, 353 patients underwent CTI-dependent AFL ablation were studied. During a median follow-up of 31.6 months, 30 patients (8.5%) received PPM implantation, 24 for sick sinus syndrome and 6 for atrioventricular block. In multivariable model, prior atrial fibrillation (AF) (HR 3.570; 95% CI 1.034–12.325; P = 0.044), lowest previous sinus heart rate (HR 0.942; 95% CI 0.898–0.988; P = 0.015), and left atrial volume index (LAVI) (HR 1.067; 95% CI 1.024–1.112; P = 0.002) were independently associated with PPM implantation after CTI-dependent AFL ablation. The best cut-off points for predicting PPM implantation were 60.1 ml/m2 for LAVI and 46 beats per minute for lowest previous sinus heart rate. Among the patients discharged without PPM implantation after ablation, sinus pause over three seconds at AFL termination during ablation was an independent predictor of PPM implantation (HR 17.841; 95% CI 4.626–68.807; P < 0.001). Physicians should be aware of the possibility of PPM implantation during follow-up after AFL ablation, especially in patients with the relevant risk factors.

Sinus node dysfunction after radiofrequency catheter ablation of atrial flutter: A case report

“…Persistent atrial arrhythmia can cause direct impairment to the SN function (Park, 2020; Umer et al, 2022; Yeh et al, 2009). Sinus node dysfunction (SND) has been reported in 8%–11% of patients after ablation of AFL and is thought to be the result of atrial remodeling and longer FCL times (>273 ms) associated with sinoatrial conduction abnormalities (Kim et al, 2022; Sairaku et al, 2012; Song et al, 2015). Unlike previous studies, the FCL in this case was shorter than 273 ms and FCL may not fully predict the occurrence of SND in patients with AFL.…”