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Stroke in paced patients with sick sinus syndrome: relevance of atrial mechanical function, pacing mode and clinical
A V Mattioli1, E T Castellani, A Fusco
1Department of Cardiology, University of Modena, Italy.
Insights
Patients with sick sinus syndrome (SSS) have a high risk of stroke. Echocardiography can identify patients with SSS who are at increased risk for cerebral ischemia and embolism.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Sick sinus syndrome (SSS) is associated with a high incidence of cerebral ischemia and peripheral emboli.
- Understanding risk factors for stroke in SSS patients is crucial for effective management.
Purpose of the Study:
- To determine the prevalence of stroke in SSS patients.
- To identify predictors of stroke, focusing on pacing mode, atrial function, and clinical status.
Main Methods:
- Prospective study of 80 SSS patients receiving pacemakers (atrial, dual chamber, or ventricular).
- Cranial CT scans at enrollment and 24 months.
- Doppler echocardiography for atrial function assessment.
- Multivariate regression analysis of clinical and echocardiographic data.
Main Results:
- Cerebral ischemia occurred in 13 patients; emboli in 2 patients.
- Univariate predictors for embolism included prior cerebrovascular disease, low atrial ejection force, and left atrial spontaneous echo contrast.
- Independent risk factors for stroke were prior cerebral ischemia, age > 65, left atrial echo contrast, and depressed atrial ejection force.
Conclusions:
- Specific echocardiographic findings (left atrial echo contrast, low atrial ejection force) predict stroke risk in SSS patients.
- Identified high-risk patient subgroups requiring closer monitoring and potentially tailored interventions.
- Highlights the importance of comprehensive echocardiographic assessment in SSS management.
Abstract:
Patients with sick sinus syndrome have a high prevalence of cerebral ischemia and emboli of the viscera and extremities. The present study was designed to establish the prevalence of stroke in patients with sick sinus syndrome, with specific attention to pacing mode, atrial function (evaluated using Doppler echocardiography) and the clinical condition of the patients. The prospective study analyzed 80 consecutive patients with sick sinus syndrome who received either atrial, dual chamber or ventricular pacemakers. Patients underwent a cranial CT scan at the time of enrollment and again at the end of the study 24 months later. End points of the study were cerebral ischemia or emboli of the viscera or extremities. Clinical and echocardiographic features were assessed at the beginning of the study. A multivariate regression analysis was applied to all variables that had at least a marginal univariate predictive value. Cerebral ischemia occurred in 13 patients and emboli of the viscera or extremities were observed in 2 patients. Univariate predictors for embolism consisted of a prior history of cerebrovascular disease (p < 0.001), low atrial ejection force (p < 0.01) and a dilated left atrium with spontaneous echo contrast (p < 0.05). Independent risk factors for stroke included a history of previous cerebral ischemia, age > 65 years, left atrial echo contrast on an echocardiogram and a depressed atrial ejection force. These findings identified patients at high risk for the development of peripheral embolism among the group of patients paced for sick sinus syndrome.