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Long-term survival after permanent pacemaker implantation for sick sinus syndrome
R T Tung1, W K Shen, D L Hayes
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
The American Journal of Cardiology
|November 15, 1994
Summary
Patients with sick sinus syndrome receiving pacemakers had worse survival, especially with structural heart disease. Pacemakers improved symptoms, but heart conditions remain key mortality factors.
Area of Science:
- Cardiology
- Electrophysiology
- Clinical Research
Background:
- Sick sinus syndrome (SSS) necessitates permanent pacemaker implantation.
- Long-term survival and prognostic factors post-pacemaker implantation for SSS require detailed examination.
Purpose of the Study:
- To evaluate long-term survival and identify prognostic factors in patients with SSS undergoing permanent pacemaker implantation.
- To compare survival rates of SSS patients with and without structural heart disease (SHD) against a matched control population.
Main Methods:
- Population-based study analyzing 148 patients with SSS who received permanent pacemakers between 1969 and 1991.
- Comparison of survival data with age- and sex-matched control populations.
- Multivariate analysis to identify independent risk factors for mortality.
Main Results:
- Overall survival for SSS patients with pacemakers was significantly worse than controls (p < 0.0001).
- Increased mortality was linked to coexisting structural heart disease (SHD) (p < 0.0001), while isolated SSS survival was comparable to controls (p = 0.6729).
- Symptoms improved in 78% of patients; congestive heart failure, valvular heart disease, stroke history, and age were independent mortality risks.
Conclusions:
- Permanent pacemaker implantation for SSS does not normalize survival, particularly in patients with underlying structural heart disease.
- Identifying and managing comorbidities like SHD is crucial for improving outcomes in SSS patients.
- While pacing improves symptoms, it does not negate the impact of cardiac structural abnormalities on long-term prognosis.