Sinus Node Dysfunction after Successful Atrial Flutter Ablation during Follow-Up: Clinical Characteristics and Predictors

Guan-Yi Li; Fa-Po Chung; Tze-Fan Chao; Yenn-Jiang Lin; Shih-Lin Chang; Li-Wei Lo; Yu-Feng Hu; Ta-Chuan Tuan; Jo-Nan Liao; Ting-Yung Chang; Ling Kuo; Cheng-I Wu; Chih-Min Liu; Shin-Huei Liu; Wen-Han Cheng; Shih-Ann Chen

doi:10.3390/jcm11113212

Sinus Node Dysfunction after Successful Atrial Flutter Ablation during Follow-Up: Clinical Characteristics and Predictors

J Clin Med. 2022 Jun 4;11(11):3212. doi: 10.3390/jcm11113212.

Authors

Guan-Yi Li^{1

2}, Fa-Po Chung^{1

2}, Tze-Fan Chao^{1

2}, Yenn-Jiang Lin^{1

2}, Shih-Lin Chang^{1

2}, Li-Wei Lo^{1

2}, Yu-Feng Hu^{1

2}, Ta-Chuan Tuan^{1

2}, Jo-Nan Liao^{1

2}, Ting-Yung Chang^{1

2}, Ling Kuo^{1

2}, Cheng-I Wu^{1

2}, Chih-Min Liu^{1

2}, Shin-Huei Liu^{1

2}, Wen-Han Cheng^{1

2}, Shih-Ann Chen^{1

2

3}

Affiliations

¹ Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
² Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan.
³ Cardiovascular Center, Taichung Veterans General Hospital, Taichung 40705, Taiwan.

Abstract

Identification of sinus node dysfunction (SND) before termination of persistent AFL by catheter ablation (CA) is challenging. This study aimed to investigate the characteristics and predictors of acute and delayed SND after AFL ablation. We retrospectively enrolled 221 patients undergoing CA of persistent AFL in a tertiary referral center. Patients with SND who required a temporary pacemaker (TPM) after termination of AFL or a permanent pacemaker (PPM) during follow-up were identified. Acute SND requiring a TPM was found in 14 of 221 (6.3%) patients following successful termination of AFL. A total of 10 of the 14 patients (71.4%) recovered from acute SND. An additional 11 (5%) patients presenting with delayed SND required a PPM during follow-up, including 4 patients recovering from acute SND. Of these, 9 of these 11 patients (81.8%) underwent PPM implantation within 1 year after the ablation. In multivariable analysis, female gender and a history of hypothyroidism were associated with the requirement for a TPM following termination of persistent AFL, while older age and a history of hypothyroidism predicted PPM implantation. This study concluded that the majority of patients with acute SND still require a PPM implantation despite the initial improvement. Therefore, it is reasonable to monitor the patients closely for at least one year after AFL ablation.

Keywords: atrial flutter; catheter ablation; permanent pacemaker; sinus node dysfunction; temporary pacemaker.

Grants and funding

This work was supported by the Ministry of Science and Technology (grant numbers MOST 109-2314-B-075-075-MY3, MOST 109-2314-B-010-058-MY2, MOST 109-2314-B-075-074-MY3, MOST 109-2314-B-075-076-MY3, MOST 107-2314-B-010-061-MY2, MOST 106-2314-B-075-006-MY3, MOST 106-2314-B-010-046-MY3, and MOST 106-2314-B-075-073-MY3), Research Foundation of Cardiovascular Medicine, Szu-Yuan Research Foundation of Internal Medicine, and Taipei Veterans General Hospital (grant numbers V106C-158, V106C-104, V107C-060, V107C-054, V109C-113, V110C-116, and V111C-159).