Journal Article

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

Cui, Chang, Liu, Hailei, Cai, Cheng, Li, Mingfang, Gu, Kai, Chen, Hongwu, Guo, Yi, Wang, Zidun, Jiang, Xiaohong, Ju, Weizhu, Shi, Jiaojiao, Chen, Minglong, Yang, Gang

2026

Overview

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. Twelve of the 1330 patients who underwent AF catheter ablation showed PSP ≥ 3 s after AF termination post ablation. The temporal characteristics of PSP were described. Nine of the 12 patients had no need for permanent pacing. We concluded that a ‘watch‐and‐wait’ strategy could be adopted in these patients.

• Publisher: John Wiley & Sons, Inc,Wiley
• Subject: Ablation / Ablation (Surgery) / Aged / Anti-arrhythmia drugs / Antiarrhythmics / Arrhythmia / Atrial fibrillation / Atrial Fibrillation - physiopathology / Atrial Fibrillation - surgery / Cardiac arrhythmia / Cardiac patients / Cardioversion / catheter ablation / Catheter Ablation - adverse effects / Catheters / Electrocardiography - methods / Female / Fibrillation / Heart failure / Humans / Male / Medical instruments / Medical research / Medicine, Experimental / Middle Aged / Observational studies / Original / pacemaker implantation / Pacemaker, Artificial / Pacemakers / Patients / Prospective Studies / Radiofrequency ablation / sinus node dysfunction / Sinuses / Strategic planning (Business) / temporary pacemaker implantation / Time Factors / Veins & arteries