Deshmukh Abhishek J, Yao Xiaoxi, Schilz Stephanie, Van Houten Holly, Sangaralingham Lindsey R, Asirvatham Samuel J, Friedman Paul A, Packer Douglas L, Noseworthy Peter A
Cardiovascular Diseases, Mayo Clinic Heart Rhythm Section, Rochester, MN, USA.
Mayo Clinic Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Rochester, MN, USA.
J Interv Card Electrophysiol. 2016 Jan;45(1):99-105. doi: 10.1007/s10840-015-0071-8. Epub 2015 Nov 6.
Sinus node dysfunction requiring pacemaker implantation is commonly associated with atrial fibrillation (AF), but may not be clinically apparent until restoration of sinus rhythm with ablation or cardioversion. We sought to determine frequency, time course, and predictors for pacemaker implantation after catheter ablation, and to compare the overall rates to a matched cardioversion cohort.
We conducted a retrospective analysis using a large US commercial insurance database and identified 12,158 AF patients who underwent catheter ablation between January 1, 2005 and December 31, 2012. Over an average of 2.4 years of follow-up, 5.6 % of the patients underwent pacemaker implantation. Using the Cox proportional hazards models, we found that risk of risks of pacemaker implantation was associated with older age (50-64 and ≥65 versus <50 years), female gender, higher CHADS2 score (≥2 and 1 versus 0), higher Charlson index (≥2 versus 0-1), certain baseline comorbidities (conduction disorder, coronary atherosclerosis, and congestive heart failure), and the year of ablation. There was no significant difference in the risk of pacemaker implantation between ablation patients and propensity score (PS)-matched cardioversion groups (3.5 versus. 4.1 % at 1 year and 8.8 versus 8.3 % at 5 years).
Overall, pacemaker implantation occurs in about 1/28 patients within 1 year of catheter ablation. The overall implantation rate decreased between 2005 and 2012. Furthermore, the risk after ablation is similar to cardioversion, suggesting that patients require pacing due to a common underlying electrophysiologic substrate, rather than the ablation itself.
需要植入起搏器的窦房结功能障碍通常与心房颤动（房颤）相关，但在通过消融或复律恢复窦性心律之前，可能在临床上并不明显。我们试图确定导管消融后起搏器植入的频率、时间进程和预测因素，并将总体发生率与匹配的复律队列进行比较。
我们使用美国一个大型商业保险数据库进行了一项回顾性分析，确定了2005年1月1日至2012年12月31日期间接受导管消融的12158例房颤患者。平均随访2.4年，5.6%的患者接受了起搏器植入。使用Cox比例风险模型，我们发现起搏器植入风险与年龄较大（50 - 64岁和≥65岁与<50岁相比）、女性、较高的CHADS2评分（≥2分和1分与0分相比）、较高的Charlson指数（≥2分与0 - 1分相比）、某些基线合并症（传导障碍、冠状动脉粥样硬化和充血性心力衰竭）以及消融年份有关。消融患者与倾向评分（PS）匹配的复律组之间起搏器植入风险无显著差异（1年时分别为3.5%和4.1%，5年时分别为8.8%和8.3%）。
总体而言，在导管消融后1年内，约1/28的患者会植入起搏器。2005年至2012年期间总体植入率有所下降。此外，消融后的风险与复律相似，这表明患者需要起搏是由于共同的潜在电生理基质，而非消融本身。
