GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département de Cardiologie, Université Catholique de Lille, F-59000 Lille, France.
GCS-Groupement des hôpitaux de l'institut Catholique de Lille/Faculté Libre de Médecine, Département d'Information Médicale, Université Catholique de Lille, F-59000 Lille, France.
Europace. 2020 Oct 1;22(10):1526-1536. doi: 10.1093/europace/euaa151.
Pacemaker implantation (PI) after atrioventricular nodal re-entry tachycardia (AVNRT) ablation is a dreadful complication. We aimed to assess periprocedural, early, and late risks for PI.
All 27 022 patients who underwent latest AVNRT ablation in France from 2009 to 2017, were identified in the nationwide medicalization database. A control group of 305 152 patients hospitalized for arm, leg, or skin injuries with no history of AVNRT or supraventricular tachycardia were selected. After propensity score matching, both groups had mean age of 53 ± 18 years and were predominantly female (64%). During this 9-year period, 822 of 27 022 (3.0%) AVNRT patients underwent PI, with significant higher risk in propensity-matched AVNRT patients compared to propensity-matched controls [2.9% vs. 0.9%; hazard ratio 3.4 (2.9-3.9), P < 0.0001]. This excess risk was significant during all follow-up, including periprocedural (1st month), early (1-6 months), and late (>6 months) risk periods. Annualized late risk per 100 AVNRT patients was 0.2%. In comparison to controls, excess risk was 0.2% in <30-year-old AVNRT patients; 0.7% in 30-50-year-old; 1.1% in 50-70-year-old and 6.5% over 70-year-olds. Risk for PI was also significantly different according to three procedural factors: centres, experience, and ablation date, with a 30% decrease since 2015.
Periprocedural, early, and late risks for PI were higher after AVNRT ablation compared to propensity-matched controls. Longer follow-up is needed as the excess risk seems to persist late after AVNRT ablation.
房室结折返性心动过速（AVNRT）消融术后植入起搏器是一种可怕的并发症。我们旨在评估围手术期、早期和晚期植入起搏器的风险。
在法国，2009 年至 2017 年间进行了最新的 AVNRT 消融术的 27022 名患者，在全国医疗数据库中被识别出来。选择了 305152 名因手臂、腿部或皮肤损伤住院且无 AVNRT 或室上性心动过速病史的患者作为对照组。在进行倾向评分匹配后，两组患者的平均年龄为 53±18 岁，且主要为女性（64%）。在这 9 年期间，27022 名 AVNRT 患者中有 822 名（3.0%）接受了 PI，与倾向评分匹配的对照组相比，AVNRT 患者的风险显著更高[2.9%比 0.9%；风险比 3.4（2.9-3.9），P<0.0001]。在整个随访期间，包括围手术期（第 1 个月）、早期（1-6 个月）和晚期（>6 个月）风险期，这种风险均显著升高。每 100 名 AVNRT 患者的年化晚期风险为 0.2%。与对照组相比，<30 岁的 AVNRT 患者风险增加 0.2%；30-50 岁的患者风险增加 0.7%；50-70 岁的患者风险增加 1.1%；70 岁以上的患者风险增加 6.5%。PI 的风险也根据三个手术因素（中心、经验和消融日期）显著不同，自 2015 年以来，风险降低了 30%。
与倾向评分匹配的对照组相比，AVNRT 消融术后围手术期、早期和晚期植入起搏器的风险更高。需要进行更长时间的随访，因为 AVNRT 消融术后晚期似乎仍存在风险。
