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
. 2024 Apr 19;103(16):e37543.
doi: 10.1097/MD.0000000000037543.

Atrial fibrillation ablation compared to pacemaker therapy in patients with tachycardia-bradycardia syndrome: A systematic review and updated meta-analysis

Lijun Su  1 , Xiaoqi Wang  2 , Fengguang Kang  2 , Caidi Gong  2 , Dezhu Chen  3
Affiliations
Meta-Analysis

Atrial fibrillation ablation compared to pacemaker therapy in patients with tachycardia-bradycardia syndrome: A systematic review and updated meta-analysis

Lijun Su et al. Medicine (Baltimore). .

Abstract

Background: Tachycardia-bradycardia syndrome (TBS) is a subtype of sick sinus syndrome characterized by prolonged sinus pause (≥3 s) following termination of tachyarrhythmias, primarily atrial fibrillation (AF). There is controversy regarding whether the long-term prognosis of AF ablation is superior to pacemaker implantation. This study aimed to compare the effects of AF ablation and pacemaker therapy in patients with TBS.

Methods: We conducted a comprehensive search of electronic databases, including PubMed, Cochrane, EmBase, Web of Science, and Chinese BioMedical, up until December 1, 2023. We included studies that reported the effects of AF ablation vs pacemaker therapy in patients with TBS. From this search, we identified 5 studies comprising 843 participants with TBS who underwent catheter AF ablation or pacemaker therapy.

Results: Our meta-analysis revealed that AF ablation and pacemaker therapy had similar effects on cardiovascular death (odds ratio [OR] = 0.62 and 95% confidence interval [CI]: 0.14-2.65), procedural complications (OR = 1.53 and 95% CI: 0.67-3.48), and cardiovascular rehospitalization (OR = 0.57 and 95% CI: 0.26-1.22). However, AF ablation provided greater benefits than pacemaker therapy in terms of all-cause mortality (OR = 0.37 and 95% CI: 0.17-0.82), thromboembolism (OR = 0.25 and 95% CI: 0.12-0.49), stroke (OR = 0.28 and 95% CI: 0.13-0.57), heart failure (OR = 0.27 and 95% CI: 0.13-0.56), freedom from AF (OR = 23.32 and 95% CI: 7.46-72.92), and prevention of progression to persistent AF (OR = 0.12 and 95% CI: 0.06-0.24). Furthermore, AF ablation resulted in a reduced need for antiarrhythmic agents (OR = 0.21 and 95% CI: 0.08-0.59).

Conclusion: AF ablation can effectively reduce the risk of all-cause mortality, thromboembolism, stroke, heart failure, and progression to persistent AF in patients with TBS. Additionally, it may eliminate the need for further pacemaker therapy in most cases after ablation. Therefore, AF ablation is considered superior to pacemaker therapy in the management of patients with TBS.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Study selection flow chart. Selection and data abstraction process, performed according to the PRISMA statement.
Figure 2.
Figure 2.
Quality assessments of included studies.
Figure 3.
Figure 3.
Meta-analysis of all the included studies on outcomes conferred by ablation vs pacing in TBS patients. Estimated effect size was derived by Mantel–Haenszel fixed-effects model and heterogeneity test P value was calculated by Cochrane Q test. Size of the box represented weight of the study on the over-all results. (A) All-cause mortality; (B) cardiovascular related death; (C) cardiovascular related rehospitalization; (D1) thromboembolism; (D2) stroke; (E) heart failure; (F) operation complications; (G) usage of antiarrhythmic agents; (H) free of AF; (I) progression to persistent AF. AF = atrial fibrillation. TBS = Tachycardia–bradycardia syndrome.
Figure 4.
Figure 4.
Publication bias of included studies. P value was derived by Egger’s test.
See this image and copyright information in PMC

References

    1. Clementy N, Andrade JG, Babuty D, et al. . Unusual tachycardia–bradycardia syndrome during atrial fibrillation: what is the mechanism? Circ Arrhythm Electrophysiol. 2013;6:e42–6. - PubMed
    1. Tse G, Liu T, Li KH, et al. . Tachycardia–bradycardia syndrome: electrophysiological mechanisms and future therapeutic approaches (Review). Int J Mol Med. 2017;39:519–26. - PMC - PubMed
    1. Lo LW, Tuan TC, Tai CT, et al. . Incessant wide QRS tachycardia after pulmonary vein isolation and pacemaker implantation in a patient with tachycardia–bradycardia syndrome. J Cardiovasc Electrophysiol. 2007;18:783–4. - PubMed
    1. Kusumoto FM, Schoenfeld MH, Barrett C, et al. . 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2019;140:e382–482. - PubMed
    1. Hocini M, Sanders P, Deisenhofer I, et al. . Reverse remodeling of sinus node function after catheter ablation of atrial fibrillation in patients with prolonged sinus pauses. Circulation. 2003;108:1172–5. - PubMed