Circulation, Vol 88, 1045-1053, Copyright © 1993 by American Heart Association
EB Sgarbossa, SL Pinski, JD Maloney, TW Simmons, BL Wilkoff, LW Castle and RG Trohman
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.
ARTICLES
Chronic atrial fibrillation and stroke in paced patients with sick sinus syndrome. Relevance of clinical characteristics and pacing modalities
Department of Cardiology, Cleveland Clinic Foundation, OH 44195.
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