![]() ![]() Patients with atrial fibrillation (AF) or atrial flutter (AFL) showed atrial remodeling, characterized by low voltage areas, slow conduction, and a reduction in atrial refractoriness 5, 6, 7. Both diseases are associated with structural and electrical atrial remodeling and stretched atria 4. Previous studies have shown the clinical association between atrial tachyarrhythmia and sinus node dysfunction (SND) 1, 2, 3. Physicians should be aware of the possibility of PPM implantation during follow-up after AFL ablation, especially in patients with the relevant risk factors. Among the patients discharged without PPM implantation after ablation, sinus pause over three seconds at AFL termination during ablation was an independent predictor of PPM implantation (HR 17.841 95% CI 4.626–68.807 P < 0.001). The best cut-off points for predicting PPM implantation were 60.1 ml/m 2 for LAVI and 46 beats per minute for lowest previous sinus heart rate. In multivariable model, prior atrial fibrillation (AF) (HR 3.570 95% CI 1.034–12.325 P = 0.044), lowest previous sinus heart rate (HR 0.942 95% CI 0.898–0.988 P = 0.015), and left atrial volume index (LAVI) (HR 1.067 95% CI 1.024–1.112 P = 0.002) were independently associated with PPM implantation after CTI-dependent AFL ablation. During a median follow-up of 31.6 months, 30 patients (8.5%) received PPM implantation, 24 for sick sinus syndrome and 6 for atrioventricular block. Between January 2011 and June 2021, 353 patients underwent CTI-dependent AFL ablation were studied. We sought to evaluate the incidence and predictors for permanent pacemaker (PPM) implantation after CTI-dependent AFL ablation. It is unclear which factors are associated with progressive sinus node dysfunction after cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) ablation.
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