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The incidence, indications and predictors of acute pacemaker implantation after ablation of persistent atrial fibrillation

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Abstract

Introduction

Patients with persistent atrial fibrillation (AF) may additionally suffer from a concealed sinus node disease. We sought to determine the incidence, indications and predictors of acute pacemaker [PM] implantation within 1 week after the ablation of persistent AF.

Methods and results

We performed a retrospective analysis of patients, who had had an ablation of persistent AF at our center. Between 01/2011 and 08/2016, 1234 patients (mean age 65 ± 10 years, 66.7% male) without prior PM implantation underwent an ablation of persistent AF. Pulmonary vein isolation (PVI) was performed in 1158 (93.8%), the additional ablation of complex fractionated atrial electrograms (CFAE) in 1109 (89.9%) and linear ablation in 524 (42.5%) patients. Temporary cardiac pacing was necessary in 27 (2.2%) patients. The temporary PM was removed in 15 patients (1.2%) because sinus node recovered after a median of 1.0 (minimum 0.1−maximum 2.0) day. The remaining 12 (1.0%) patients required the implantation of a permanent PM. Another 13 (1.1%) patients required permanent PM implantation without prior temporary pacing. In a multivariable regression model, age [OR 1.07 (1.02–1.12), p = 0.006], sinus pauses prior to ablation [OR 7.97 (2.36–26.88), p = 0.001] and atria with low voltage [OR 2.83 (1.31–6.11), p = 0.008] were identified as significant predictors for acute cardiac pacing.

Conclusion

Acute cardiac pacing within 1 week after the ablation of persistent AF was necessary in 40 (3.2%) patients. Age, sinus pauses in history prior to ablation and the existence of low-voltage areas in the atria were identified as relevant risk factors.

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Authors and Affiliations

  1. Klinik für Herz-und Kreislauferkrankungen, Abteilung Elektrophysiologie, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany

    Verena Semmler, Felix von Krogh, Tilko Reents, Felix Bourier, Marta Telishevska, Marc Kottmaier, Marielouise Kornmayer, Stephanie Brooks, Katharina Koch-Büttner, Carsten Lennerz, Amir Brkic, Christian Grebmer, Patrick Blazek, Severin Weigand, Gabriele Hessling, Christof Kolb & Isabel Deisenhofer

  2. Klinikum rechts der Isar, Institut für Medizinische Informatik, Statistik und Epidemiologie, Technische Universität München, Munich, Germany

    Bernhard Haller

  3. DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany

    Carsten Lennerz

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  1. Verena Semmler
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  2. Felix von Krogh
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Corresponding author

Correspondence to Verena Semmler.

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On behalf of all authors, the corresponding author states that there is no conflict of interest concerning this study.

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Semmler, V., von Krogh, F., Haller, B. et al. The incidence, indications and predictors of acute pacemaker implantation after ablation of persistent atrial fibrillation. Clin Res Cardiol 108, 651–659 (2019). https://doi.org/10.1007/s00392-018-1393-1

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  • DOI: https://doi.org/10.1007/s00392-018-1393-1

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