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[Sick sinus syndrome (extrinsic and intrinsic form) during long term observation]
Z Ciemniewski1, J Myszor, L Giec
1I Klinika Kardiologii Instytutu Kardiologii Slaskiej Akademii Medycznej.
Insights
Syncope, age, and persistent bradycardia independently predict pacemaker implantation in sick sinus syndrome patients. Older age and persistent syncope post-pacemaker implantation are stroke risk factors.
Area of Science:
- Cardiology
- Electrophysiology
- Internal Medicine
Background:
- Sick sinus syndrome (SSS) encompasses intrinsic and extrinsic forms of sinus node dysfunction.
- Long-term follow-up is crucial for understanding outcomes in SSS patients.
Purpose of the Study:
- Identify independent factors for pacemaker implantation in SSS.
- Determine independent risk factors for stroke and other complications in SSS patients, particularly those with pacemakers.
Main Methods:
- Prospective study of 169 SSS patients with abnormal electrophysiological tests.
- Sinus node dysfunction type determined by electrophysiological study post-pharmacological denervation (propranolol and atropine).
- Statistical analysis using Cox proportional hazards model with a follow-up of 14-84 months.
Main Results:
- Pacemaker implantation occurred in 88 patients during the observation period.
- Seven patients experienced stroke signs, with six occurring post-pacemaker implantation.
- Thirteen deaths were recorded, including seven sudden or primary neurological deaths.
Conclusions:
- Syncope, advanced age, and persistent bradycardia were independent predictors for pacemaker implantation.
- The type of sinus node dysfunction (intrinsic vs. extrinsic) was not an independent factor for pacemaker implantation.
- Older age, persistent syncope post-pacemaker implantation, and ventriculo-atrial condition were independent stroke risk factors in VVI-paced patients.
- Despite residual syncope episodes, pacemaker implantation significantly improved quality of life for SSS patients.
Unlabelled:
The aim of the study has to be find, on basis of long term follow-up, an independent factors determining of pacemaker implantation in patients with intrinsic and extrinsic form of sick sinus syndrome. The second point was to find an independent risk factors of stroke and another serious complication in this group of patients (specially in paced group). The study group consisted 169 pts with sick sinus syndrome (in all pts abnormal electrophysiological tests--transoesophageal atrial stimulation). The form of sinus node dysfunction (extrinsic or intrinsic) was determined on basis of electrophysiological study after pharmacological denervation of the heart (propranolol and atropine i.v. in doses 0.2 and 0.04 mg/kg body weight respectively). The statistical analysis was performed on all pts (97 men and 72 women 48 +/- 16 yrs old) using Cox's model of proportional hazardous analysing. The follow-up period ranging from 14 to 84 months (mean 49.9 +/- 19). Pacemaker was implanted in 88 pts during observation period. Stroke signs were found in 7 pts including 6 pts after pacemaker implantation. There was 13 death (7 sudden or primary neurological death).
Conclusions:
1) independent factors of pacemaker implantation were syncope, age and persistent bradycardia, 2) form of sinus node dysfunction was not an independent factor of this decision, 3) age (older), persistent after pacemaker implantation syncope and registered in transesophageal ecg ventriculo-atrial condition were independent risk factors of stroke in pts with VVI stimulation, 4) despite of pacemaker implantation (VVI mode) many patients have presyncopal or syncope attacks but life comfort in this group was much better then before implantation.