[Implantation of atrial pacemaker in patients with sinoatrial failure]

From 1990 to 1997 a total of 42 atrial pacemakers (41 of them rate responsive) were implanted in patients with sick sinus syndrome at Aust-Agder Central Hospital, Arendal, Norway. 22 women and 20 men aged 42-86 years (average 69 years) were treated. Follow-up time was from 1-80 months (average 26 months). Sinusbradycardia and sinoatrial block were diagnosed in 17 patients, whereas 25 patients suffered from tachybrady syndrome. It was not necessary to change the pacemaker in any of the patients. One patient developed a second degree atrioventricular, Wenckebach type block, two patients developed permanent atrial fibrillation after seven and 43 months, respectively, and five patients were treated for paroxysmal atrial fibrillation. Thus, 34 patients had no need of antiarrhythmic treatment in the follow-up period. Although over 30% of patients who need a pacemaker in Norway suffer from sick sinus syndrome, only 8-12% of them are treated with atrial pacemakers. Recent studies have demonstrated that in patients with sick sinus syndrome there is greater improvement in prognosis and quality of life with physiological pacing than with ventricular pacing. Therefore, more patients should be considered for implantation of atrial pacemakers.