Catheter ablation of atrial fibrillation in patients with concomitant sinus bradycardia—Insights from the German Ablation Registry

• CA of AF in sinus bradycardia is performed with high procedural efficacy.
• In patients with normal rates, three-dimensional mapping was predominantly employed.
• Conventional mapping was more often used in patients with sinus bradycardia.
• Procedures and RF application times were longer in patients with sinus bradycardia.
• Major complications were rare but more frequent in patients with sinus bradycardia.

AimsThis investigation addresses procedural characteristics of catheter ablation in patients with atrial fibrillation (AF) and sinus bradycardia.MethodsFrom the prospective, multi-center German Ablation Registry 1073 patients with sinus rhythm at the time of AF ablation were divided into two groups according to heart rate at start of procedure (A, < 60 beats per minute (bpm), n = 197; B, 60–99 bpm, n = 876).ResultsAcute procedural success was high (≥ 98%) and similar between groups. Procedure duration and energy application time were increased in group A (180 min vs. 155 min and 2561 s vs. 1879 s, respectively). Major complications were more frequent in group A (2.2% vs. 0.5%), and a greater proportion of these patients was discharged under antiarrhythmic medication (64% vs. 52%).ConclusionCatheter ablation of AF with concomitant sinus bradycardia is associated with high procedural efficacy, longer procedure- and energy application durations, and a slightly elevated complication rate.