Procedural Complexity and Outcomes of Catheter Ablation for Atrial Fibrillation in Patients With Sick Sinus Syndrome

BACKGROUND: The procedural complexity and outcomes of atrial fibrillation (AF) ablation in patients with sick sinus syndrome (SSS) remain unclear. This study aimed to evaluate procedural strategies, including pulmonary vein isolation (PVI) and additional ablation, and AF recurrence according to SSS status. METHODS AND RESULTS: This retrospective study included 53 patients with SSS and 623 without SSS undergoing initial radiofrequency AF ablation. PVI-plus ablation was defined as any ablation targeting the cavotricuspid isthmus (CTI) for common atrial flutter (AFL), non-pulmonary vein (non-PV) foci, or atrial tachycardia. PVI-plus ablation and AF recurrence were compared using 1:5 propensity score matching (53 with SSS and 265 without SSS). PVI-plus was more frequent in the SSS group than in the non-SSS group (47% vs. 29%, p = 0.005), particularly CTI ablation (38% vs. 21%, p = 0.005) and non-PV foci ablation (15% vs. 7%, p = 0.026). SSS was associated with higher odds of PVI-plus (odds ratio 2.087; 95% CI, 1.146-3.787). AF recurrence at 36 months did not differ significantly between SSS and non-SSS (42% vs. 31%; sHR 1.314; 95% CI, 0.812-2.127). During follow-up, new permanent pacemaker implantation was required in seven SSS patients (13%). CONCLUSION: Patients with SSS more frequently underwent PVI-plus ablation for AFL or non-PV foci, yet long-term AF recurrence was comparable to that in non-SSS patients, underscoring the importance of careful assessment for concomitant atrial arrhythmias in this population.