Temporal Characteristics and Management of Prolonged Sinus Pause Following Atrial Fibrillation Termination After Catheter Ablation—A Preliminary Study

Abstract

Introduction

Prolonged sinus pause (PSP) after atrial fibrillation (AF) termination shortly after catheter ablation seems to be a reversible phenomenon without further need for pacemaker implantation (PMI). However, no mature management strategy has been established.

Methods

In this prospective observational study, we included consecutive patients who developed PSP ≥ 3 s upon AF termination during hospitalization following AF ablation at our center between October 2020 and October 2022. Regular follow-up was conducted.

Results

Twelve patients (mean age 66.3 ± 8.5 years; 7 females) were included. PSP ≥ 3 s upon AF termination initiated at a median of 2.0 days (IQR: 1.3–3.8) post-ablation and resolved by 5.0 days (IQR: 3.5–7.5). Three patients received temporary PMI, all of which were removed before discharge without further pacing. One patient underwent permanent PMI during hospitalization due to Adams-Stokes syndrome. After discharge, one patient received permanent pacing for symptomatic sinus arrest at 3 months, and another underwent atrioventricular node ablation followed by permanent pacing due to recurrent arrhythmia. The remaining patients had no related symptoms or need for pacing during follow-up.

Conclusion

PSP ≥ 3 s upon AF termination shortly after catheter ablation appears to be reversible. A watch-and-wait strategy was practical. Management may involve discontinuation of antiarrhythmic drugs or temporary pacing support. A small proportion of patients may ultimately require permanent PMI.