Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Oct 1;23(10):646-654.
doi: 10.2459/JCM.0000000000001360.

Catheter ablation for treatment of bradycardia-tachycardia syndrome: is it time to consider it the therapy of choice? A systematic review and meta-analysis

Massimo Magnano  1 , Arianna Bissolino  2 , Carlo Budano  2 , Mohamed Abdirashid  1 , Chiara Devecchi  1 , Domenico Oriente  1 , Mario Matta  1 , Eraldo Occhetta  1 , Fiorenzo Gaita  2 , Francesco Rametta  1
Affiliations
Meta-Analysis

Catheter ablation for treatment of bradycardia-tachycardia syndrome: is it time to consider it the therapy of choice? A systematic review and meta-analysis

Massimo Magnano et al. J Cardiovasc Med (Hagerstown). .

Abstract

Background: Atrial fibrillation catheter ablation (AFCA) should be considered as a strategy to avoid pacemaker (PM) implantation for patients with bradycardia-tachycardia syndrome (BTS), but lack of evidence is remarkable.

Methods: Our aim was to conduct a random-effects model meta-analysis on safety and efficacy data from controlled trials and observational studies. We compared atrial fibrillation (AF) recurrence, AF progression, procedural complication, additional procedure, cardiovascular death, cardiovascular hospitalization, heart failure and stroke in patients undergoing AFCA vs. PM implantation.

Results: PubMed/MEDLINE, Cochrane Database and Google Scholar were screened, and four retrospective studies were selected. A total of 776 patients (371 in the AFCA group, 405 in the PM group) were included. After a median follow-up of 67.5 months, lower AF recurrence [odds ratio (OR) 0.06, confidence interval (CI) 0.02-0.18, I2 = 82.42%, P < 0.001], AF progression (OR 0.12, CI 0.06-0.26, I2 = 0%, P < 0.001), heart failure (OR 0.12, CI 0.04-0.34, I2 = 0%, P < 0.001), and stroke (OR 0.30, CI 0.15-0.61, I2 = 0%, P = 0.001) were observed in the AFCA group. No differences were observed in cardiovascular death and hospitalization (OR 0.48, CI 0.10-2.28, I2 = 0%, P = 0.358 and OR 0.43, CI 0.14-1.29, I2 = 87.52%, P = 0.134, respectively). Higher need for additional procedures in the AFCA group was highlighted (OR 3.65, CI 1.51-8.84, I2 = 53.75%, P < 0.001). PM implantation was avoided in 91% of BTS patients undergoing AFCA.

Conclusions: AFCA in BTS patients seems to be more effective than PM implantation in reducing AF recurrence and PM implantation may be waived in most BTS patients treated by AFCA. Need for additional procedures in AFCA patients is balanced by long-term benefit in clinical end points.

PubMed Disclaimer

References

    1. Ferrer MI. The sick sinus syndrome in atrial disease. JAMA 1968; 206:645–646.
    1. Rubenstein JJ, Schulman CL, Yurchak PM, DeSanctis RW. Clinical spectrum of the sick sinus syndrome. Circulation 1972; 46:5–13.
    1. Gomes JA, Kang PS, Matheson M, Gough WB Jr, El-Sherif N. Coexistence of sick sinus rhythm and atrial flutter-fibrillation. Circulation 1981; 63:80–86.
    1. Kaplan BM. The tachycardia-bradycardia syndrome. Med Clin North Am 1976; 60:81–99.
    1. John RM, Kumar S. Sinus node and atrial arrhythmias. Circulation 2016; 133:1892–1900.