Concomitant ablation of atrial fibrillation: New pacemakers and early rhythm recovery

Objective New permanent pacemaker (PPM) implantation after concomitant atrial fibrillation (AF) ablation has been associated with surgical ablation (SA). We sought to determine factors for PPM use, and early rhythm recovery. Methods From 2004 through 2019, 6135 patients underwent valve surgery and were grouped by: No AF (n=4584), AF no SA (n=346), and AF with SA (n=1205) to evaluate predischarge PPM and 3-month rhythm recovery (intrinsic heart rate >40bpm). Results Overall, 282 (4.6%) patients required a predischarge PPM: atrioventricular node dysfunction (AVND) in 75.3%, sick sinus syndrome (SSS) in 19.1%, both (5%) and indeterminate (0.7%). Patients with AF had more PPMs: AF with SA (7.9%) versus AF no SA (6.9%) versus No AF (3.6%; P<0.001). For AF patients, PPM rates were not significantly higher for ablation patients (7.6% SA vs 6.9% AF no SA; P=0.56). There were differences in PPM by SA lesion set (biatrial 12.8%; left atrial only 6.1%; pulmonary vein isolation 3.0%; P<0.001). Among AF treated patients with 3-month PPM follow-up, rhythm recovery was common 35/62 (56.5%) and did not differ by lesion set. Rhythm recovery was 63/141 (44.7%) in the AVND group versus 24/35 (68.6%) in the SSS group (P=0.011). In propensity score-matched groups, late survival was similar (P=0.63) for new PPM patients. Conclusions Avoiding conduction system trauma and delaying implantation reduces the need for postoperative PPM. Rhythm recovery within 3 months is frequent, especially for patients with SSS. A conservative approach to the implantation of a new PPMs is warranted.