Pacemaker implantation after catheter ablation for atrial fibrillation

Abhishek J. Deshmukh, Xiaoxi Yao, Stephanie Schilz, Holly Van Houten, Lindsey R. Sangaralingham, Samuel J. Asirvatham, Paul A. Friedman, Douglas L. Packer, Peter A. Noseworthy

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Sinus node dysfunction requiring pacemaker implantation is commonly associated with atrial fibrillation (AF), but may not be clinically apparent until restoration of sinus rhythm with ablation or cardioversion. We sought to determine frequency, time course, and predictors for pacemaker implantation after catheter ablation, and to compare the overall rates to a matched cardioversion cohort. Methods and results: We conducted a retrospective analysis using a large US commercial insurance database and identified 12,158 AF patients who underwent catheter ablation between January 1, 2005 and December 31, 2012. Over an average of 2.4 years of follow-up, 5.6 % of the patients underwent pacemaker implantation. Using the Cox proportional hazards models, we found that risk of risks of pacemaker implantation was associated with older age (50–64 and ≥65 versus <50 years), female gender, higher CHADS2 score (≥2 and 1 versus 0), higher Charlson index (≥2 versus 0–1), certain baseline comorbidities (conduction disorder, coronary atherosclerosis, and congestive heart failure), and the year of ablation. There was no significant difference in the risk of pacemaker implantation between ablation patients and propensity score (PS)-matched cardioversion groups (3.5 versus. 4.1 % at 1 year and 8.8 versus 8.3 % at 5 years). Conclusion: Overall, pacemaker implantation occurs in about 1/28 patients within 1 year of catheter ablation. The overall implantation rate decreased between 2005 and 2012. Furthermore, the risk after ablation is similar to cardioversion, suggesting that patients require pacing due to a common underlying electrophysiologic substrate, rather than the ablation itself.

Original languageEnglish (US)
Pages (from-to)99-105
Number of pages7
JournalJournal of Interventional Cardiac Electrophysiology
Issue number1
StatePublished - Jan 1 2016


  • Ablation
  • Atrial fibrillation
  • Epidemiology
  • Pacemaker

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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