Sick sinus syndrome treated with permanent pacemaker in 109 patients. A follow-up study

During the last decade implantation of permanent pacemakers has become the treatment of choice for patients suffering from the sick sinus syndrome (SSS). We have followed up 112 SSS patients treated with permanent pacemakers in Haukeland Hospital in the period 1966--76. The pacemakers were later removed from three of the patients. In the remaining 109 patients the SSS was characterized by tachy-bradyarrhythmias (TBA) in 44 and bradyarrhythmias (BA) in 65. Before implantation, 68 patients had syncopes and 27 severe dizziness. After implantation, symptomatic improvement was apparent in 104 patients; only three still had syncopes. During the follow-up period (mean 34.4 months), 29 patients died (yearly mortality 9.3%). There was no significant difference in total mortality between patients with TBA and with BA. Concomitant disturbances in atrioventricular (AV) conduction occurred in 35.8% of the patients. Among 79 of 80 patients still alive, five had developed total AV block, 19 had stable atrial fibrillation, 12 of these were possibly pacemaker-independent (ventricular rate greater than 60/min). Systemic embolization was observed in 16 patients, more frequently in the TBA (12/44) than in the BA group (4/65) (p less than 0.001). It is concluded that permanent pacemakers have an excellent symptomatic effect in patients with SSS. The prognosis is mainly determined by the presence or absence of coronary heart disease and/or heart failure.