CA-532-04 HIGHER NEED FOR PACEMAKER IN WOMEN WITH SINUS NODE DYSFUNCTION DUE TO DELAY IN ATRIAL FIBRILLATION ABLATION

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 catheter ablation of AF (CA) timing and need for PPM in SSS has not been assessed. The primary aim of this study was to look at the association between timing of catheter ablation after diagnosis of atrial fibrillation and the need for a pacemaker. We used pooled electronic health data to perform retrospective cross sectional analysis of 66,595 patients with AF and SSS to assess the need of PPM implantation temporally with atrial fibrillation performed earlier within 5 years (group 1), 5-10 years (group 2), or beyond 10 years (group 3) of diagnosis. Pacemaker implantation was lowest amongst those with CA within 5 years; group 1 versus group 2 (18.15 % vs 27.21 %) and group 1 versus group 3 (18.15 % vs 27.22%). 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 pacemaker implantation, timing of AF ablation was the strongest predictor for need for PPM. Women had delay in atrial fibrillation ablation (62.3% men versus 37.7% women in group 1) compared to men leading to significantly higher need for pacemaker implantation as shown in the forest plot showing the adjusted odd ratio of pacemaker in various groups (p<0.001). (The dots represent the odds ratio and the horizontal lines represents the 95% confidence intervals). Earlier ablation of atrial fibrillation was associated with reduction in need for pacemaker implantation. Women received atrial fibrillation ablation later leading to higher need for pacemaker implantation.