Acute Sinus Node Dysfunction after Atrial Ablation: Incidence, Risk Factors, and Management

Ammar M. Killu, Erin A. Fender, Abhishek J. Deshmukh, Thomas M. Munger, Philip A Araoz, Peter A. Brady, Yong-Mei Cha, Douglas L Packer, Paul Andrew Friedman, Samuel J Asirvatham, Peter Noseworthy, Siva Mulpuru

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Many patients with atrial fibrillation (AF) or atrial flutter (Aflutter) have concomitant sinus node dysfunction (SND). Ablation may result in injury to the sinus node complex or its blood supply resulting in sinus arrest and need for temporary pacing. We sought to characterize patients who develop acute SND (ASND) during/immediately after AF/Aflutter ablation. Methods: We performed a retrospective analysis of AF/Aflutter ablation patients between January 1, 2010 and February 28, 2015 to characterize those who required temporary pacemaker (TPM) implantation due to ASND (sinus arrest, sinus bradycardia <40 beats/min, or junctional rhythm with hemodynamic compromise) following atrial ablation. Results: Of 2,151 patients, eight patients (<0.5%) with ASND manifesting as sinus arrest (n = 2), severe sinus bradycardia (n = 2), and junctional rhythm with hemodynamic compromise (n = 4) were identified (all male, age 66 ± 9.9 years, 4/8 [50%] persistent AF). AF ablation was performed in four, atypical Aflutter in one, and AF/Aflutter in three patients. The ablation set consisted of: pulmonary vein (PV) isolation (n = 6), roof line ablation (n = 6), mitral annulus-left inferior PV line ablation (n = 5), left atrial appendage-mitral annulus ablation (n = 1), cavotricuspid isthmus ablation (n = 5), and isolation or ablation near the superior vena cava (SVC, n = 4). Patients with peri-SVC ablation were more likely to develop ASND (P = 0.03). All patients received TPM; six received permanent pacemaker before discharge, performed 3.5 days postablation (range 2–6 days). At 3-month device interrogation, all patients were atrially paced >50%. Conclusion: ASND is a rare complication of atrial ablation. It may be more common when peri-SVC ablation is performed and may necessitate permanent pacemaker implantation.

Original languageEnglish (US)
Pages (from-to)1116-1125
Number of pages10
JournalPACE - Pacing and Clinical Electrophysiology
Volume39
Issue number10
DOIs
StatePublished - Oct 1 2016

Fingerprint

Sick Sinus Syndrome
Atrial Flutter
Risk Management
Atrial Fibrillation
Incidence
Sinoatrial Node
Bradycardia
Wounds and Injuries

Keywords

  • ablation
  • atrial fibrillation
  • pacemaker
  • sinus node dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Acute Sinus Node Dysfunction after Atrial Ablation : Incidence, Risk Factors, and Management. / Killu, Ammar M.; Fender, Erin A.; Deshmukh, Abhishek J.; Munger, Thomas M.; Araoz, Philip A; Brady, Peter A.; Cha, Yong-Mei; Packer, Douglas L; Friedman, Paul Andrew; Asirvatham, Samuel J; Noseworthy, Peter; Mulpuru, Siva.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 39, No. 10, 01.10.2016, p. 1116-1125.

Research output: Contribution to journalArticle

@article{e3699e30a9c74101a9d02185721b561c,
title = "Acute Sinus Node Dysfunction after Atrial Ablation: Incidence, Risk Factors, and Management",
abstract = "Background: Many patients with atrial fibrillation (AF) or atrial flutter (Aflutter) have concomitant sinus node dysfunction (SND). Ablation may result in injury to the sinus node complex or its blood supply resulting in sinus arrest and need for temporary pacing. We sought to characterize patients who develop acute SND (ASND) during/immediately after AF/Aflutter ablation. Methods: We performed a retrospective analysis of AF/Aflutter ablation patients between January 1, 2010 and February 28, 2015 to characterize those who required temporary pacemaker (TPM) implantation due to ASND (sinus arrest, sinus bradycardia <40 beats/min, or junctional rhythm with hemodynamic compromise) following atrial ablation. Results: Of 2,151 patients, eight patients (<0.5{\%}) with ASND manifesting as sinus arrest (n = 2), severe sinus bradycardia (n = 2), and junctional rhythm with hemodynamic compromise (n = 4) were identified (all male, age 66 ± 9.9 years, 4/8 [50{\%}] persistent AF). AF ablation was performed in four, atypical Aflutter in one, and AF/Aflutter in three patients. The ablation set consisted of: pulmonary vein (PV) isolation (n = 6), roof line ablation (n = 6), mitral annulus-left inferior PV line ablation (n = 5), left atrial appendage-mitral annulus ablation (n = 1), cavotricuspid isthmus ablation (n = 5), and isolation or ablation near the superior vena cava (SVC, n = 4). Patients with peri-SVC ablation were more likely to develop ASND (P = 0.03). All patients received TPM; six received permanent pacemaker before discharge, performed 3.5 days postablation (range 2–6 days). At 3-month device interrogation, all patients were atrially paced >50{\%}. Conclusion: ASND is a rare complication of atrial ablation. It may be more common when peri-SVC ablation is performed and may necessitate permanent pacemaker implantation.",
keywords = "ablation, atrial fibrillation, pacemaker, sinus node dysfunction",
author = "Killu, {Ammar M.} and Fender, {Erin A.} and Deshmukh, {Abhishek J.} and Munger, {Thomas M.} and Araoz, {Philip A} and Brady, {Peter A.} and Yong-Mei Cha and Packer, {Douglas L} and Friedman, {Paul Andrew} and Asirvatham, {Samuel J} and Peter Noseworthy and Siva Mulpuru",
year = "2016",
month = "10",
day = "1",
doi = "10.1111/pace.12934",
language = "English (US)",
volume = "39",
pages = "1116--1125",
journal = "PACE - Pacing and Clinical Electrophysiology",
issn = "0147-8389",
publisher = "Wiley-Blackwell",
number = "10",

}

TY - JOUR

T1 - Acute Sinus Node Dysfunction after Atrial Ablation

T2 - Incidence, Risk Factors, and Management

AU - Killu, Ammar M.

AU - Fender, Erin A.

AU - Deshmukh, Abhishek J.

AU - Munger, Thomas M.

AU - Araoz, Philip A

AU - Brady, Peter A.

AU - Cha, Yong-Mei

AU - Packer, Douglas L

AU - Friedman, Paul Andrew

AU - Asirvatham, Samuel J

AU - Noseworthy, Peter

AU - Mulpuru, Siva

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background: Many patients with atrial fibrillation (AF) or atrial flutter (Aflutter) have concomitant sinus node dysfunction (SND). Ablation may result in injury to the sinus node complex or its blood supply resulting in sinus arrest and need for temporary pacing. We sought to characterize patients who develop acute SND (ASND) during/immediately after AF/Aflutter ablation. Methods: We performed a retrospective analysis of AF/Aflutter ablation patients between January 1, 2010 and February 28, 2015 to characterize those who required temporary pacemaker (TPM) implantation due to ASND (sinus arrest, sinus bradycardia <40 beats/min, or junctional rhythm with hemodynamic compromise) following atrial ablation. Results: Of 2,151 patients, eight patients (<0.5%) with ASND manifesting as sinus arrest (n = 2), severe sinus bradycardia (n = 2), and junctional rhythm with hemodynamic compromise (n = 4) were identified (all male, age 66 ± 9.9 years, 4/8 [50%] persistent AF). AF ablation was performed in four, atypical Aflutter in one, and AF/Aflutter in three patients. The ablation set consisted of: pulmonary vein (PV) isolation (n = 6), roof line ablation (n = 6), mitral annulus-left inferior PV line ablation (n = 5), left atrial appendage-mitral annulus ablation (n = 1), cavotricuspid isthmus ablation (n = 5), and isolation or ablation near the superior vena cava (SVC, n = 4). Patients with peri-SVC ablation were more likely to develop ASND (P = 0.03). All patients received TPM; six received permanent pacemaker before discharge, performed 3.5 days postablation (range 2–6 days). At 3-month device interrogation, all patients were atrially paced >50%. Conclusion: ASND is a rare complication of atrial ablation. It may be more common when peri-SVC ablation is performed and may necessitate permanent pacemaker implantation.

AB - Background: Many patients with atrial fibrillation (AF) or atrial flutter (Aflutter) have concomitant sinus node dysfunction (SND). Ablation may result in injury to the sinus node complex or its blood supply resulting in sinus arrest and need for temporary pacing. We sought to characterize patients who develop acute SND (ASND) during/immediately after AF/Aflutter ablation. Methods: We performed a retrospective analysis of AF/Aflutter ablation patients between January 1, 2010 and February 28, 2015 to characterize those who required temporary pacemaker (TPM) implantation due to ASND (sinus arrest, sinus bradycardia <40 beats/min, or junctional rhythm with hemodynamic compromise) following atrial ablation. Results: Of 2,151 patients, eight patients (<0.5%) with ASND manifesting as sinus arrest (n = 2), severe sinus bradycardia (n = 2), and junctional rhythm with hemodynamic compromise (n = 4) were identified (all male, age 66 ± 9.9 years, 4/8 [50%] persistent AF). AF ablation was performed in four, atypical Aflutter in one, and AF/Aflutter in three patients. The ablation set consisted of: pulmonary vein (PV) isolation (n = 6), roof line ablation (n = 6), mitral annulus-left inferior PV line ablation (n = 5), left atrial appendage-mitral annulus ablation (n = 1), cavotricuspid isthmus ablation (n = 5), and isolation or ablation near the superior vena cava (SVC, n = 4). Patients with peri-SVC ablation were more likely to develop ASND (P = 0.03). All patients received TPM; six received permanent pacemaker before discharge, performed 3.5 days postablation (range 2–6 days). At 3-month device interrogation, all patients were atrially paced >50%. Conclusion: ASND is a rare complication of atrial ablation. It may be more common when peri-SVC ablation is performed and may necessitate permanent pacemaker implantation.

KW - ablation

KW - atrial fibrillation

KW - pacemaker

KW - sinus node dysfunction

UR - http://www.scopus.com/inward/record.url?scp=84990236735&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84990236735&partnerID=8YFLogxK

U2 - 10.1111/pace.12934

DO - 10.1111/pace.12934

M3 - Article

C2 - 27530090

AN - SCOPUS:84990236735

VL - 39

SP - 1116

EP - 1125

JO - PACE - Pacing and Clinical Electrophysiology

JF - PACE - Pacing and Clinical Electrophysiology

SN - 0147-8389

IS - 10

ER -