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. 1999 Apr;81(4):412–418. doi: 10.1136/hrt.81.4.412

Arterial thromboembolism in patients with sick sinus syndrome: prediction from pacing mode, atrial fibrillation, and echocardiographic findings

H Andersen 1, J Nielsen 1, P Thomsen 1, L Thuesen 1, A Pedersen 1, P Mortensen 1, T Vesterlund 1
PMCID: PMC1729005  PMID: 10092569

Abstract

OBJECTIVE—To evaluate whether thromboembolism in sick sinus syndrome can be predicted by pacing mode, atrial fibrillation, or echocardiographic findings.
METHODS—Patients were randomised to single chamber atrial (n = 110) or ventricular (n = 115) pacing. They were divided into subgroups with and without brady-tachy syndrome at time of randomisation. The occurrence of atrial fibrillation and thromboembolism during follow up were investigated and compared with echocardiographic findings.
RESULTS—The annual risk of thromboembolism was 5.8% in patients with brady-tachy syndrome randomised to ventricular pacing, 3.2% in patients without brady-tachy syndrome randomised to ventricular pacing, 3% in patients with brady-tachy syndrome randomised to atrial pacing, and 1.5% in patients without brady-tachy syndrome randomised to atrial pacing. In atrial paced patients without brady-tachy syndrome at randomisation and without atrial fibrillation during follow up, the annual risk of thromboembolism was 1.4%. Left atrial size measured by M mode echocardiography was of no value in predicting thromboembolism.
CONCLUSIONS—Arterial thromboembolism in patients with sick sinus syndrome is very common and is associated primarily with brady-tachy syndrome at randomisation and with ventricular pacing. The risk of thromboembolism is small in atrial paced patients in whom atrial fibrillation has never been documented.

 Keywords: sick sinus syndrome; atrial pacing; atrial fibrillation; thromboembolism

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Figure 1  .

Figure 1  

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Kaplan-Meier plots of freedom from arterial thromboembolism during follow up in patients randomised to single chamber atrial (AAI) or ventricular (VVI) pacing stratified in groups without brady-tachy syndrome (A) and with brady-tachy syndrome (B) at randomisation. Figures below abscissa indicate number of patients at risk during follow up.

Figure 2  .

Figure 2  

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Cumulative number of arterial thromboembolic events during follow up in patients without brady-tachy syndrome at randomisation (A) and in patients with brady-tachy syndrome at randomisation (B) in the two treatment groups. AAI, single chamber atrial pacing; VVI, single chamber ventricular pacing.

Figure 3  .

Figure 3  

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Kaplan-Meier plots of freedom from arterial thromboembolism during follow up in patients randomised to single chamber atrial (AAI) or ventricular (VVI) pacing stratified into two groups: patients without brady-tachy syndrome at randomisation and without atrial fibrillation during follow up (A), and patients with brady-tachy syndrome at randomisation and/or atrial fibrillation during follow up (B).

Selected References

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