| 최종일¹, 박희남¹, 곽재진¹, 장진근¹, 박재석¹, 김용현¹, 임홍의¹, Chun Hwang², 김영훈¹ |
Background: Although the implantation of permanent pacemaker (PI) has been used for the therapy of tachycardia-bradycardia syndrome (TBS) with paroxysmal atrial fibrillation (PAF), radiofrequency catheter ablation (RFCA) of PAF is known to be effective for curing TBS. We hypothesized that RFCA for PAF leads to better long term outcome than PI in patients with TBS with PAF.
Methods: We retrospectively compared 19 patients with TBS with PAF treated by PI (66.3±8.1 yrs, 10 male) and 25 patients who underwent RFCA (61.3±10.5 yrs, 13 male). There were no differences in LA size, LVEF, AF duration, and the incidence of syncope or pre-syncope between two groups. The mean durations of sinus pause recorded on Holter ECG were 4.9±2.4 sec and 6.1±3.5 sec, respectively (p=NS).
Results: 1. During 36.2±36.4 months follow-up, the episodes of syncope or presyncope occurred in 5.3% (1/19) of PI group (63.8±39.8 months) and 12.0% (3/25) in RFCA group (15.2±11.2 months), respectively (p=NS). 2. In spite of higher incidence of taking anti-arrhythmic drugs (AAD) in PI group (68.4% in PI vs. 24.0% in RFCA, p<0.01), PI group had higher episodes of AF (98.5% in PI vs. 20.0% in RFCA, p<0.001). PAF was converted to persistent AF in 50.0% of PI group, in contrast, in none of RFCA group (p<0.001). 3. The maintenance of warfarin was higher in PI group (44.8%) than in RFCA group (4.3%, p<0.01). 4. The number of hospitalization was higher in PI group (1.8±0.7 times per patient including generator change (36.8%)) than in RFCA group (1.3±0.7 times per patient, p<0.05). 5. 14.3% (3/19) of PI group underwent RFCA due to recurrent symptomatic AF, and 12.0% (3/25) of RFCA group underwent implantation of pacemaker due to TBS upon termination of recurrent PAF.
Conclusion: Compared to PI, RFCA for PAF led better long term outcome (incidence of persistent AF, rate of taking AAD and warfarin, and hospitalization) in patients with TBS. Even our results were from the retrospective study including small sized number of patients, RFCA needs to be considered as the first-line therapy in patients with PAF with TBS.
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