Clinical Study On Catheter Ablation For Atrial Fibrillation Complicated With Tachycardia-bradycardia Syndrome

PurposeLong interval after paroxysmal atrial fibrillation to sinus rhythm is a common clinical situation.Pacemaker implantation and atrial fibrillation catheter ablation are currently commonly used to treat the disease.The purpose of this study was to evaluate the changes in sinoatrial node function,predictive factors for permanent pacemaker implantation,and long-term efficacy analysis of atrial fibrillation with Tachycardia-bradycardia syndrome after catheter ablation,and to provide a reference for clinical decision-making for such patients.MethodsA retrospective analysis was adopted for 98 patients with atrial fibrillation complicated with Tachycardia-bradycardia syndrome who underwent catheter ablation from January 2012 to Decemebr 2018 at a Cardiovascular Hospital of Xiamen University.The changes of sinoatrial node function and the risk factors of permanent pacemaker implantation were analyzed by self-control.In addition,300 patients with common paroxysmal atrial fibrillation during the same period were randomly selected as the control group.Basic clinical data of the two groups of patients were collected to analyze and compare the recurrence rate of AF,pacemaker implantation rate,re-hospitalization rate,stroke rate,etc and to assess the clinical prognosis.ResultCompared with the longest RR interval(4.69 ± 1.21s),fastest heart rate(130.55 ± 35.13 beats/min)and slowest heart rate(38.86±7.04 beats/min)before catheter ablation,the longest RR interval(1.39±0.32s,1.52±0.28s,1.92± 0.39s),and the fastest heart rate(103.79±18.07 beats/minute,94.33±8.83)times/min,97.47 ± 11.01 times/min)decreased significantly;the slowest heart rate(55.00 ± 10.81 beats/min,54.00 ± 1.00 beats/min,52.00±7.21 beats/min)increased significantly on January,June,and December after catheter ablation;P values less than 0.05.There is no statistical difference among the three groups at 1 month,6 months,and 12 months after Catheter ablation.There are totally ten patients who were required implantation of a permanent pacemaker at(13.15 ± 8.23)months after catheter ablation.Compared with patients without permanent pacemakers,the longest RR interval was significantly longer in patients with permanent pacemakers(7.28 ± 0.69s vs 4.28±0.24s,P=0.01).the risk of long-term pacemaker implantation is significantly increased for patients with AF complicated with TBS who have a longest RR interval greater than 5.8s by further ROC curve analysis.Compared with patients with paroxysmal atrial fibrillation,there is no statistical difference from the recurrence rate of AF(18.36%vs 16.0%,P=0.78),the rate of re-hospitalization(9.18%vs 11.33%,P=0.80),and the stroke rate(0%vs 0%,p=1).ConclusionThe catheter ablation for atrial fibrillation complicated with Tachycardia-bradyca-rdia syndrome can improve sinus node function to a certain extent.Compared with patients with common paroxysmal atrial fibrillation,there was no significant difference in the recurrence rate of AF,the rate of re-hospitalization related to cardiovascular disease,and the incidence of stroke after catheter ablation.However,the risk of long-term pacemaker implantation is significantly increased for patients with AF complicated with TBS who have a longest RR interval greater than 5.8s.