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. 2024 Dec;168(6):1677-1685.e1.
doi: 10.1016/j.jtcvs.2023.10.030. Epub 2023 Oct 20.

Concomitant ablation of atrial fibrillation: New pacemakers and early rhythm recovery

Andrei Churyla  1 , Patrick M McCarthy  2 , Jane Kruse  1 , Adin-Cristian Andrei  3 , Rachel Kaplan  4 , Rod S Passman  5 , James L Cox  1
Affiliations

Concomitant ablation of atrial fibrillation: New pacemakers and early rhythm recovery

Andrei Churyla et al. J Thorac Cardiovasc Surg. 2024 Dec.

Abstract

Objective: New permanent pacemaker (PPM) implantation after concomitant atrial fibrillation (AF) ablation has been associated with surgical ablation (SA). We sought to determine factors for PPM use as well as early rhythm recovery.

Methods: From 2004 through 2019, 6135 patients underwent valve surgery and were grouped: No AF (n = 4584), AF no SA (n = 346), and AF with SA (n = 1205) to evaluate predischarge PPM and 3-month rhythm recovery (intrinsic heart rate >40 beats per minute).

Results: Overall, 282 (4.6%) patients required a predischarge PPM: atrioventricular node dysfunction in 75.3%, sick sinus syndrome in 19.1%, both (5%), and indeterminate (0.7%). Patients with AF had more PPMs: AF with SA (7.9%) versus AF no SA (6.9%) versus No AF (3.6%) (P < .001). For patients with AF, PPM rates were not significantly higher for ablation patients (7.6% SA vs 6.9% AF no SA; P = .56). There were differences in PPM by SA lesion set (biatrial 12.8%; left atrial only 6.1%; pulmonary vein isolation 3.0%; P < .001). Among patients with AF treated with 3-month PPM follow-up, rhythm recovery was common (35 out of 62 [56.5%]) and did not differ by lesion set. Rhythm recovery was seen in 63 out of 141 (44.7%) in the atrioventricular node dysfunction group versus 24 out of 35 (68.6%) in the sick sinus syndrome group (P = .011). In propensity score-matched groups, late survival was similar (P = .63) for new PPM patients.

Conclusions: Avoiding conduction system trauma and delaying implantation reduces the need for postoperative PPM. Rhythm recovery within 3 months is frequent, especially for patients with sick sinus syndrome. A conservative approach to the implantation of a new PPMs is warranted.

Keywords: atrial fibrillation; pacemaker dependence; postoperative pacemaker; rhythm recovery after cardiac surgery; valve surgery.

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Conflict of interest statement

Conflict of Interest Statement Dr McCarthy has received speaking fees and royalties from Edwards Lifesciences; speaking fees form Medtronic and Atricure; is a surgical primary investigator (REPAIR-MR Trial) for Abbott; and is on the advisory board for Egnite. Dr Passman is on the advisory boards of Janssen, Medtronic, Abbott, and iRhythm; has provided research support for the American Heart Association, National Institutes of Heath, and Apple; and has received royalties from UpToDate. Dr Cox is on the Board of Directors and is a stockholder and consultant for Adagio Medical; is a stockholder and consultant for Atricure and PVAMed Inc; and is on the clinical advisory board and is a stockholder for PotentiaMetrics Inc. Dr Kaplan has received royalties from UpToDate. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.