Cor Vasa 2002, 43(12):509-512

Is the atrial pacemaker a reliable solution in the treatment of patients with the sick sinus syndrome?

Novák M^1,*, Kamarýt P¹, Dvořák I jr.¹, Vykypěl T¹, Müllerová J¹, Mach P², Reška M²

¹ I. interní-kardioangiologická klinika

² I. chirurgická klinika, Fakultní nemocnice u sv. Anny a Masarykova univerzita, Brno, Česká republika

Aim:
To follow, in patients with AAI(R) PM, the occurrence of atrial fibrillation (AF) or any other supraventricular tachyarrhythmia (SVTA) as well as the occurrence of atrioventricular block of degree II or III (AVB II, III). To find out how often and at what time after the first implantation these complications led to the necessity of ventricular lead implantation and switchover to DDD (VVI) pacing.


Patients, material and methods:
AAI (81) or AAIR (41) PMs were implanted to 122 consecutive patients (with a mean age of 64.8 ± 13.6 years) over a period of 15 years. Input criteria: SSS, Wenckebach point > 120 . min-1, without AVB II, III, without bundle branch block and without AF (or another SVTA) in the documentation. Average follow-up time: 96.9 ± 49.9 (12-180) months. Number of deaths 28, lost from follow-up 2. The group of patients was evaluated retrospectively.

Results:
Depending on illness development, the surviving patients with AAI(R) PM, n = 92, were divided into 6 groups: (1) uncomplicated development (without AF or other SVTA and without AVB II, III) 64.1%, (2) paroxysmal AF (or other SVTA) controllable by antiarrhythmics (7.6%), (3) frequent AF (or other SVTA) with the necessity of implanting a ventricular lead and changing the mode from AAI to DDD (10.6%), (4) permanent AF with the necessity of changing AAI to VVI (1.1%), (5) AVB II with the necessity of changing the pacing from AAI to DDD (14.1%), (6) AVB II + AF (or another SVTA) with the necessity of changing AAI pacing to DDD (2.1%).

Conclusion:
With the application of AAI(R) PM (after an average follow-up period of 96.9 ± 49.9 months), there was a frequent occurrence of AF (or another SVTA) and/or AVB II (or a drop in the Wenckebach point) with the necessity of implanting the ventricular lead and changing the pacing mode to DDD in 25 out of the 92 surviving patients (27.2%). The implication is that, with the sick sinus syndrome (even without AF or another SVTA, without bundle branch block and without AVB II, III in the documentation), the method of choice is the use of the DDD(R) PM already at the time of first implantation.

Keywords: Sick sinus syndrome; Sinus node disease; AAI pacing; DDD pacing

Published: November 1, 2002  Show citation