Clinical observations with long-term atrial pacing

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Atrial pacing (AP) provides hemodynamic and antiarrhythmic benefits but remains underutilized.
• Sick sinus syndrome (SSS) encompasses bradycardia and tachycardia-bradycardia syndromes, often requiring pacing.
• Long-term outcomes of AP in SSS patients require further evaluation.

Purpose of the Study:

• To assess the long-term efficacy and safety of atrial pacing in patients with sick sinus syndrome.
• To evaluate the antiarrhythmic effects and impact on quality of life.
• To identify factors influencing the development of conduction disturbances.

Main Methods:

• A retrospective study of 64 patients with SSS treated with AP between 1982-1996.
• Patients were selected based on specific criteria, including absence of AV block and adequate atrial function.
• Follow-up evaluations were conducted every 3-6 months, with a mean follow-up of 67 months.

Main Results:

• All 33 patients with sinus bradycardia (SB) maintained sinus rhythm without developing AV block.
• Among 27 patients with tachycardia-bradycardia syndrome (TBS), 20 achieved significant reduction in paroxysmal attacks, improving quality of life.
• Seven TBS patients developed chronic atrial fibrillation, with 3 experiencing cerebral embolism; 3 had temporary AV block that resolved with medication adjustment.

Conclusions:

• Atrial pacing is a safe and reliable long-term treatment for sick sinus syndrome.
• Proper patient selection is critical for preventing AV conduction disturbances.
• Atrial pacing demonstrates a satisfactory long-term antiarrhythmic effect in SSS patients.