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Systemic embolism in chronic sinoatrial disorder
Insights
Systemic embolism is prevalent in patients with sino-atrial disorder, particularly those with bradycardia-tachycardia syndrome. Atrial dysfunction significantly increases embolism risk, even with stable atrial fibrillation.
Area of Science:
- Cardiology
- Vascular Medicine
- Electrophysiology
Background:
- Systemic embolism poses a significant risk in patients with cardiac rhythm disorders.
- Chronic sino-atrial disorder is associated with various arrhythmias, including bradycardia-tachycardia syndrome.
Purpose of the Study:
- To estimate the prevalence of systemic embolism in patients diagnosed with chronic sino-atrial disorder.
- To compare embolism rates between patients with sino-atrial disorder and controls with chronic complete heart block.
Main Methods:
- A cohort of 100 patients with chronic sino-atrial disorder was assessed for evidence of systemic embolism.
- A control group of 712 patients with chronic complete heart block, matched for age and sex, was used for comparison.
- A second patient group (n=41) with chronic ventricular bradycardia and atrial flutter/fibrillation was also analyzed.
Main Results:
- Systemic embolism was detected in 16% of patients with sino-atrial disorder, with 15% having bradycardia-tachycardia syndrome.
- Embolism prevalence in sino-atrial disorder patients (16%) was significantly higher than in controls (1.3%, P < 0.001).
- Patients with ventricular bradycardia and atrial flutter/fibrillation showed a higher embolism rate (7.3%) compared to controls (P < 0.05).
Conclusions:
- Chronic sino-atrial disorder, especially bradycardia-tachycardia syndrome, is linked to a high prevalence of systemic embolism.
- Impaired atrial function is identified as a critical factor for intracardiac thrombosis and subsequent embolization.
- The risk of embolization persists even with conversion to stable atrial fibrillation, and paroxysmal supraventricular tachycardia elevates this risk.
Abstract:
We attempted to estimate the prevalence of systemic embolism in patients with chronic sino-atrial disorder. In a group of 100 patients, evidence of embolism was found in 16, of whom 15 had the bradycardia-tachycardia syndrome. In 712 controls with chronic complete heart block, who were matched for age and sex, embolism had occurred in only 1.3 per cent (P less than 0.001). A second group of 41 patients with chronic ventricular bradycardia and atrial flutter or fibrillation had an embolic prevalence of 7.3 per cent, which was also greater than that in the controls (P less than 0.05). All patients with sinoatrial disorder in whom systemic embolism developed were over 54 years of age; multiple episodes occurred in six. The risk of embolization remains even if the bradycardia-tachycardia syndrome is replaced by stable atrial fibrillation. Impaired atrial function appears to be a key factor in predisposing to intracardiac thrombosis, and paroxysmal supraventricular tachycardia increases the risk of subsequent embolization.