| 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 |
Abstract/OtherAbstract:
|
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. |
| | |
Authors:
|
E B Sgarbossa; S L Pinski; J D Maloney; T W Simmons; B L Wilkoff; L W Castle; R G Trohman |
Related Documents
:
|
747226 - Ultrastructure of the collagen fibril. ii. evidence of the spiral organization of the f... 12417846 - Is the presence of interatrial septal hypertrophy a marker for atrial fibrillation in t... 8038026 - Heterogeneity and time course of improvement in cardiac function after cardioversion of... 19375546 - The patient with atrial fibrillation. 16429846 - Reversible hypocalcemic heart failure with t wave alternans and increased qtc dispersio... 8624866 - Induction of ventricular fibrillation predicts sudden death in patients treated with am... |
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 |
Affiliation:
|
Department of Cardiology, Cleveland Clinic Foundation, OH 44195. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Actuarial Analysis Aged Atrial Fibrillation / epidemiology* Cardiac Pacing, Artificial / methods* Cerebrovascular Disorders / epidemiology* Chronic Disease Female Humans Incidence Male Morbidity 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
Previous Document: Comparative mechanisms of antiarrhythmic drug action in experimental atrial fibrillation. Importance...
Next Document: Electrocardiographic correlates of spontaneous termination of ventricular tachycardia in patients wi...