Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Heart Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Heart Rhythm. 2019 Aug;16(8):1182-1188. doi: 10.1016/j.hrthm.2019.02.032. Epub 2019 Feb 28.
Catheter ablation of the slow pathway is the standard treatment of atrioventricular nodal reentry tachycardia (AVNRT) with a well described low risk of periprocedural atrioventricular block. Less is known about the risk of pacemaker implantation late after ablation.
We aimed to quantify the risk of late pacemaker implantation in a countrywide cohort undergoing first-time ablation for AVNRT.
All patients undergoing first-time ablation for AVNRT in Sweden from 2004 to 2014 were identified from the Swedish catheter ablation registry and matched against the Swedish Pacemaker and ICD registry. The cohort was compared to patients ablated for an accessory pathway (AP) and to matched controls.
During follow-up of 2039 days, pacemaker was implanted later than 30 days after ablation in 96 of 6842 patients with AVNRT (1.4%), 29 of 4065 patients with AP (0.7%) (P = .001), and 124 of 33,270 controls (0.4%) (P < .00001). A periprocedural pacemaker (≤30 days postablation) was implanted in 32 of 6877 patients with AVNRT (0.5%) and 9 of 4079 patients with AP (0.2%) (P = .05). With cryoablation, 5 patients needed periprocedural pacemaker implantation. Pacemakers were implanted before ablation in 88 of 6977 patients with AVNRT (1.3%) and 11 of 4100 patients with AP (0.3%); the prevalence of pacemaker implants in controls was 124 of 33,270 (0.4%) (P < .00001 for both comparisons).
The risk of late pacemaker implantation after AVNRT ablation was low but 3 times higher than that in the control population and 3 times higher than the risk of periprocedural pacemaker implantation. Similar results were observed with cryoablation and radiofrequency ablation. Ablation may not be the cause of increased late pacemaker implantation risk.
经导管消融慢径是治疗房室结折返性心动过速（AVNRT）的标准方法，其围手术期房室传导阻滞的风险较低。然而，对于消融术后晚期起搏器植入的风险了解较少。
我们旨在量化全国首次接受 AVNRT 消融的患者中晚期起搏器植入的风险。
从瑞典导管消融登记处确定了 2004 年至 2014 年间首次接受 AVNRT 消融的所有患者，并与瑞典起搏器和 ICD 登记处进行了匹配。该队列与接受旁路（AP）消融的患者和匹配的对照组进行了比较。
在 2039 天的随访中，96 例 AVNRT 患者（1.4%）、29 例 AP 患者（0.7%）（P =.001）和 124 例对照组患者（0.4%）（P <.00001）在消融后 30 天以上需要植入起搏器。6877 例 AVNRT 患者中有 32 例（0.5%）和 4079 例 AP 患者中有 9 例（0.2%）（P =.05）在围手术期植入起搏器。在接受冷冻消融的 5 例患者中，需要植入围手术期起搏器。6977 例 AVNRT 患者中有 88 例（1.3%）和 4100 例 AP 患者中有 11 例（0.3%）在消融前已植入起搏器；对照组中起搏器植入的患病率为 33270 例中的 124 例（0.4%）（这两种比较均 P <.00001）。
AVNRT 消融后晚期起搏器植入的风险较低，但比对照组高 3 倍，比围手术期起搏器植入的风险高 3 倍。冷冻消融和射频消融也观察到类似的结果。消融术可能不是晚期起搏器植入风险增加的原因。
