1. ΝΟΣΟΣ ΤΑΧΥΒΡΑΔΥΚΑΡΔΙΑΣ: ΕΜΦΥΤΕΥΣΗ ΒΗΜΑΤΟΔΟΤΗ Η ΚΑΤΑΛΥΣΗ ΚΟΛΠΙΚΗΣ ΜΑΡΜΑΡΥΓΗΣ ;
ΓΕΩΡΓΙΟΣ ΣΤΑΥΡΟΠΟΥΛΟΣ ΕΠ.Α ΚΑΡΔΙΟΛΟΓΟΣ ΓΝΘ ΙΠΠΟΚΡΑΤΕΙΟ

2. SINUS NODE DISFUNCTION
Sinus node dysfunction (SND)
comprises a variety of abnormalities
sinus arrest,
sinus bradycardia,
sinoatrial block
alternating episodes of tachycardia and bradycardia
large proportion of SND patients have atrial fibrillation (AF) and prolonged sinus pauses after AF termination`:tachycardia-bradycardia syndrome.
natural course
recurrent syncope,
heart failure,
stroke
and
atrial fibrillation

3. Sinus Node Disease structural and temporal characteristics
anatomic and structural abnormalities, including atrial enargement, regions of low voltage, and scarring
Wide Spread conduction slowing and anatomically determined conduction delay
increased right atrial refractoriness.
CSNRT was significantly prolonged in patients with SND
Other investigators showed that transient sinus node remodelling was induced by 10– 15 min of rapid atrial pacing even in patients without sinus node dysfunction
Sanders et al Atrial Remodeling in Sinus Node Disease
Circulation March 30, 200

6. PACEMAKER COMPLICATIONS
The American Journal of Cardiology Vol. 92 September 15, 2003

7. PACING INDUCED CARDIOMYOPATHY

9. Management of AF

11. Pacing vs AF ablation for tachycardia-bradycardia Syndrome
Cure of AF by pulmonary vein isolation helped resolve the clinical manifestations of sick
sinus syndrome, suggesting that the occurrence of AF and/or the associated treatment could be partially responsible for sick sinus syndrome Natale et al.
Journal of Cardiovascular Electrophysiology
Vol. 15, No. 7, July 2004

13. All 43 patients in the ABL group fulfilled Class I indication for pacemaker implantation at baseline but they actually underwent AF ablation. Reevaluation after months of follow-up showed that 41 patients ± (95.3%) did no longer need a pacemaker (Class III indication). Total cardiac-related rehospitalization was not significantly different between the two groups (P = 0.921). Tachycardia-related hospitalization was significantly higher in the PM group than the ABL group (14.0% and 0%, P =0.029). More patients in the PM group were on AADs (PM 40.4%, ABL 4.7%, P< ) while sinus rhythm maintenance was remarkably higher in the ABL group at the end of follow-up (83.7% vs 21.1% in PM group, P< ).

14. When the indication for permanent pacing was reassessed after 20. 1 9
When the indication for permanent pacing was reassessed after months of follow-up, 95.3% ± (41/43) of the patients of the ABL group were no longer indicated permanent pacing (Class III indication) the two patients who received AAD (amiodarone and propafenone, respectively) after ablation did not develop any AAD-related Bradycardia after the procedure Sinus rhythm was maintained in 83.7% in the ABL group and 21.1% in the PM group at the last procedure P< of 43 (97.7%) patients had avoided the implantation of pacemaker

15. Pacing vs AF ablation for tachycardia-bradycardia Syndrome
AF ablation obviated permanent pacemaker implantations in the majority of the patients with SSS and PAF, and SSS type 1 was a sole factor predicting pacemaker implantations
Heart and Vessels
Received: 1 May 2018 / Accepted: 31 August 2018

16. Pacing vs AF ablation for tachycardia-bradycardia Syndrome
Three patients (8%) required pacemaker implantation, one for the gradual progression of sinus dysfunction during a period of 6.5 years and the others for recurrence of TBS 3.5 and 5.5 years after ablation, respectively
Progression of sinus node dysfunction can occur after a long period of time despite the elimination of atrial tachyarrhythmia in TBS patients, a careful follow-up is warranted
Europace (2014) 16, 208–213
K. Inada et al.

18. CONCLUSIONS

19. CONCLUSIONS
catheter ablation of AF seems effective in treating paroxysmal AF-related tachycardia-bradycardia syndrome in terms of restoration of sinus rhythm without necessity of permanent pacing;
Curative AF ablation can render patients pacemakerfree
Ablation seems to have higher rates of sinus rhythm maintenance off AADs compared to pacemaker insertion plus AADs;
Patients who undergo pacemaker implantation are associated with more tachyarrhythmia-related hospitalizations than those who undergo AF ablation.
in TBS patients, a longer-careful follow-up is warranted
limitations of ablation approach in terms of types of bradycardia, stage of AF, left atrial size, age and comorbidities, and amount of atrial fibrosis are unknown

20. AF Treatment is Complex