B-po04-073 earlier catheter ablation of atrial fibrillation mitigates the need for pacemaker placement in those with sinus node dysfunction

Atrial fibrillation (AF) is associated with anatomical and electrical remodeling. Some patients with AF have concomitant sick sinus syndrome (SSS) and may need pacemaker (PPM) implantation. Association between AF ablation (ABL) timing and need for PPM in SSS has not been assessed. We used pooled electronic health data to evaluate the need of PPM implantation in those with AF and SSS if ABL done earlier within 5 years, 5-10 years or beyond 10 years. Retrospective cross-sectional analysis of patients with AF who were also diagnosed with SSS by using a large electronic health record-based database called IBM Explorys. Primary outcome was percentage of PPM implantation after ABL within 5 years of diagnosis of AF and SSS (group 1), within 6-10 years of diagnosis (group 2), and after 10 years or no ABL at all (group 3). 66595 patients with AF and SSS were included in the analysis. Risk of PPM implantation was lowest with ABL within 5 years; group1 vs group 2 (18.15 % vs 27.21 %, OR 0.59 [0.50- 0.71]) and group1 vs group 3 ((18.15 % vs 27.22 %, OR 0.59 [0.55- 0.64]) respectively. Interestingly there was no difference in risk of PPM between group 2 and group 3 ((27.21 % vs 27.22 %, OR 1.00 [0.85- 1.20]). Even after controlling known risk factors of need for pacing, timing of AF ablation was strongest predictor for need for PPM; patients adjusted odds (aOR) of PPM was lower if patient had ABL within 5 years of AF as compared to later than 5 years (aOR 0.64 [0.59- 0.70]). Atrial fibrillation ablation within 5 years of diagnosis of AF and SSS lead to statistically significant decrease in need for pacemaker implantation compared to AF ablation after more than 5 years of diagnosis.Tabled 1TABLE 1: Multivariable ModelMultivariable ModelOR (95% CI) in OverallStudy PopulationAge65 or above vs younger than 651.50 (1.43-1.57)SexFemale Vs Male1.20 (1.16 -1.25)HypertensionPresence Vs Absence1.61 (1.52-1.71)Congestive Heart FailurePresence Vs Absence1.17 (1.12-1.23)Coronary Artery DiseasePresence Vs Absence1.22 (1.18- 1.27)Bundle Branch BlockPresence Vs Absence1.30 (1.24- 1.37)Time of Atrial Fibrillation AblationGroup 1 vs. 30.64 (0.59-0.70)Group 2 vs. 31.01 (0.86-1.19) Open table in a new tab