Document Detail

Chronic atrial fibrillation and stroke in paced patients with sick sinus syndrome. Relevance of clinical characteristics and pacing modalities.
MedLine Citation:
PMID:  8353866     Owner:  NLM     Status:  MEDLINE    
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 [HR] = 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.
E B Sgarbossa; S L Pinski; J D Maloney; T W Simmons; B L Wilkoff; L W Castle; R G Trohman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  88     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1993 Sep 
Date Detail:
Created Date:  1993-09-23     Completed Date:  1993-09-23     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1045-53     Citation Subset:  AIM; IM    
Department of Cardiology, Cleveland Clinic Foundation, OH 44195.
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MeSH Terms
Actuarial Analysis
Atrial Fibrillation / epidemiology*
Cardiac Pacing, Artificial / methods*
Cerebrovascular Disorders / epidemiology*
Chronic Disease
Multivariate Analysis
Pacemaker, Artificial*
Proportional Hazards Models
Retrospective Studies
Risk Factors
Sick Sinus Syndrome / epidemiology,  therapy*
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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