Patients With Sick Sinus Syndrome
نویسندگان
چکیده
Background. The goal of the report was to study the long-term incidence and the independent predictors for chronic atrial fibrillation and stroke in 507 paced patients with sick sinus syndrome, adjusting for differences in baseline clinical variables with multivariate analysis. Methods and Results. From 1980 to 1989, we implanted 376 dual-chamber, 19 atrial, and 112 ventricular pacemakers to treat patients with sick sinus syndrome. After a maximum follow-up of 134 months (mean: 59±38 months for chronic atrial fibrillation, 65±37 months for stroke), actuarial incidence of chronic atrial fibrillation was 7% at 1 year, 16% at 5 years, and 28% at 10 years. Independent predictors for this event, from Cox's proportional hazards model, were history of paroxysmal atrial fibrillation (P<.001; hazard ratio [HRJ =16.84), use of antiarrhythmic drugs before pacemaker implant (P<.001; HR=2.25), ventricular pacing mode (P=.003; HR=1.98), age (P=.005; HR=1.03), and valvular heart disease (P=.008; HR=2.05). For patients with preimplant history of paroxysmal atrial fibrillation, independent predictors were prolonged episodes of paroxysmal atrial fibrillation (P<.001; HR=2.56), long history of paroxysmal atrial fibrillation (P=.004; HR=2.05), ventricular pacing mode (P=.025; HR=1.69), use of antiarrhythmic drugs before pacemaker implant (P=.024; HR=1.71), and age (P=.04; HR=1.02). Actuarial incidence of stroke was 3% at 1 year, 5% at 5 years, and 13% at 10 years. Independent predictors for stroke were history of cerebrovascular disease (P<.001; HR=5.22), ventricular pacing mode (P=.008; HR=2.61), and history of paroxysmal atrial fibrillation (P=.037; HR=2.81). Conclusions. Development of chronic atrial fibrillation and stroke in paced patients with sick sinus syndrome are strongly determined by clinical variables and secondarily by the pacing modality. Ventricular pacing mode predicts chronic atrial fibrillation in patients with preimplant paroxysmal atrial fibrillation but not in those without it. (Circulation. 1993;88:1045-1053.)
منابع مشابه
Benefits of dual chamber pacing in sick sinus syndrome.
The effects of DDD (fully automatic) and VVI (ventricular demand) pacing modes on exercise tolerance, symptom diary cards, and Holter monitoring were investigated in a randomised double blind crossover study of 16 patients who had had DDD pacemakers implanted because of frequent syncope. Eight patients presented with sick sinus syndrome and, with one exception, retrograde atrioventricular condu...
متن کاملDifferent distribution of abnormal endocardial electrograms within the right atrium in patients with sick sinus syndrome.
BACKGROUND Prolonged and fractionated right atrial endocardial electrograms are characteristic of paroxysmal atrial fibrillation (idiopathic or associated with sick sinus syndrome). The distribution of these abnormal atrial electrograms within the right atrium and the way it is related to the likelihood that patients with sick sinus syndrome will develop paroxysmal atrial fibrillation was studi...
متن کاملStudies on the Mechanism of Sinus Node Dysfunction in the Sick Sinus Syndrome JAY
The intrinsic heart rate (IHR) was determined in 17 patients with symptomatic sinus bradycardia by administering atropine 0.04 mg/kg and propranolol 0.2 mg/kg, i.v. In this way, sick sinus (SSS) patients with intrinsic sinus node (SN) dysfunction could be distinguished from those patients with disturbed autonomic regulation of SN function. Sick sinus syndrome patients with normal corrected sinu...
متن کاملThe sick sinus syndrome. A study of 15 cases.
The long term prognosis was studied in 50 patients treated for the sick sinus syndrome with pacemaker insertion. The mean age of the patients was 71 years. There were 31 females and 19 males in the series. Nine patients (18%) died during the average follow-up period of 19 months. Dizzy and syncopal episodes were abolished in most patients with pacemaker therapy. However only two of the nine pat...
متن کاملThe origins of the sinus node pacemaker complex in man: demonstration of dominant and subsidiary foci.
To test the hypothesis that the human sinus node is capable of demonstrating multiple sites of impulse generation, we assessed spontaneous shifts in the sinus node pacemaker complex, and shifts after overdrive atrial pacing, premature atrial stimulation and carotid sinus massage. A total of 24 patients aged 59 +/- 15 years (mean +/- SD) in whom stable sinus node electrograms were obtained were ...
متن کاملClinical Spectrum of the Sick Sinus Syndrome
The clinical spectrum of the sick sinus syndrome (SSS) is described in a series of 56 patients who demonstrated either persistent unexplained sinus bradyeardia (group I: eight patients); sinus arrest (group II: 15 patients); or bradyeardia with episodic supraventricular tachyarrhythmias (group III: 33 patients). Coronary disease was the most common form of heart disease where etiology could be ...
متن کامل