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Long-term Clinical Outcomes of Radiofrequency Catheter Ablation versus Permanent Pacemaker Implantation in Patients with Tachycardia-Bradycardia Syndrome

Korean Circulation Journal 2020년 50권 11호 p.998 ~ 1009
조상철, 진은선, 엄상용, 황기원, 최형오, 김기헌, 김성환, 박경민, 김준, 최기준, 김유호, 남기병,
소속 상세정보
조상철 ( Cho Sang-Cheol ) - University of Ulsan College of Medicine Asan Medical Center Department of Internal Medicine
진은선 ( Jin Eun-Sun ) - Kyung Hee University Hospital at Gangdong Cardiovascular Center
엄상용 ( Om Sang-Yong ) - University of Ulsan College of Medicine Asan Medical Center Department of Internal Medicine
황기원 ( Hwang Ki-Won ) - Pusan National University School of Medicine Pusan National University Yangsan Hospital Department of Internal Medicine
최형오 ( Choi Hyung-Oh ) - Soonchunhyang University College of Medicine Soonchunhyang University Hospital Department of Internal Medicine
김기헌 ( Kim Ki-Hun ) - Inje University College of Medicine Haeundae Paik Hospital Department of Internal Medicine
김성환 ( Kim Sung-Hwan ) - Catholic University College of Medicine Department of Internal Medicine
박경민 ( Park Kyoung-Min ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Internal Medicine
김준 ( Kim Jun ) - University of Ulsan College of Medicine Asan Medical Center Department of Internal Medicine
최기준 ( Choi Ki-Joon ) - University of Ulsan College of Medicine Asan Medical Center Department of Internal Medicine
김유호 ( Kim You-Ho ) - University of Ulsan College of Medicine Asan Medical Center Department of Internal Medicine
남기병 ( Nam Gi-Byoung ) - University of Ulsan College of Medicine Asan Medical Center Department of Internal Medicine

Abstract


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.

키워드

Atrial fibrillation; Catheter ablation; Pacemaker, artificial

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