Long-term Clinical Outcomes of Radiofrequency Catheter Ablation versus Permanent Pacemaker Implantation in Patients with Tachycardia-Bradycardia Syndrome
Autor: | Sang Cheol Cho, You Ho Kim, Ki-Hun Kim, Eun Sun Jin, Hyung Oh Choi, Jun Kim, Ki Won Hwang, Kyoung-Min Park, Ki Joon Choi, Gi-Byoung Nam, Sang Yong Om, Sung-Hwan Kim |
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Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
medicine.medical_treatment Catheter ablation 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Internal medicine Internal Medicine Medicine Sinus rhythm In patient 030212 general & internal medicine business.industry Medical record Hazard ratio Atrial fibrillation medicine.disease Confidence interval Pacemaker artificial Radiofrequency catheter ablation Cardiology Original Article Cardiology and Cardiovascular Medicine business |
Zdroj: | Korean Circulation Journal |
ISSN: | 1738-5555 1738-5520 |
Popis: | Background and objectives Pacemaker (PM) implantation is a well-accepted treatment option for patients with paroxysmal atrial fibrillation (AF) and related tachycardia-bradycardia syndrome (TBS). Data on the long-term clinical outcomes after radiofrequency catheter ablation (RFCA) or PM implantation are sparse. Methods The medical records of 217 patients with TBS were retrospectively assessed. Outcomes in patients who underwent RFCA (n=108, 49.8%) were compared to those with PM implantation (n=109, 50.2%). The clinical outcomes were sinus rhythm maintenance, conversion to persistent AF, additional procedure or crossover, and the composite of cardiovascular hospitalization and death. Results During the follow-up period (mean 3.5±2.0 years), the RFCA group, compared to the PM group, showed better sinus rhythm maintenance (adjusted hazard ratio [aHR], 0.27; 95% confidence interval [CI], 0.15-0.46; p=0.002) and less progression to persistent AF (aHR, 0.20; 95% CI, 0.06-0.63; p=0.006). Additional procedure or crossover did not differ significantly between the groups (aHR, 2.07; 95% CI, 0.71-6.06; p=0.185 and aHR, 0.69; 95% CI, 10.8-2.67; p=0.590, respectively). Most RFCA patients (92.6%) did not require pacemaker implantation during long term follow-up period (>3.5 years). The composite endpoint of cardiovascular rehospitalization and death was not significantly different between the groups (aHR, 0.92; 95% CI, 0.50-1.66; p=0.769). Conclusions RFCA is an effective alternative to PM implantation in patients with TBS. In these patients, successful RF ablation of AF is related to a higher rate of sinus rhythm maintenance compared to PM implantation, and the composite outcome of cardiovascular rehospitalization and death is similar. |
Databáze: | OpenAIRE |
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