Relation of Prognosis to Age, Conduction of Permanent
in Sick Sinus Syndrome Defects and Modes Cardiac Pacing
Massimo Santini, MD, Georgia Alexidou, MD, Gerard0 Ansalone, MD, Giuseppe Cacciatore, MD, Roberto Cini, MD, and Gioia Turitto, MD A large population of sick sinus syndrome (SSS) patients was analyzed to determine whether age of patients, presence of conduction disturbances and mode of permanent pacing are related to the occurrence of supraventricular tachyarrhythmias, cerebral embolism and cardiac mortality. Three hundred thirty-nine patients permanently paced (135 AAI, 79 DDD, 125 VW) because of SSS were followed for a mean period of 5 years (range 2 to 10). Patients were divided into 4 groups according to age (70 years) and the presence or absence of an associated conduction disturbance. Sixty-eight percent of VVI, 55% of AAI and 40.5% of DDD patients were >70 years of age. In the VVI and DDD groups a conduction disturbance was present in 67 of 204 (33%) patients; conduction disturbances were more common in patients >70 years old (46 of 111,41%) than in those 140 beats/min) remained unchanged during the follow-up period in 62% of AAI patients. In 9% of these patients, the Wenckebach threshold showed some degree of deterioration, but only in 2 patients was it 140 beats/min. The DDD mode was selected in the following 3 circumstances: the presence of atrioventricular block or intraventricular conduction disturbances; the absence of atrioventricular block or intraventricular conduction disturbances when atria1 pacing at rest induced type I second-degree atrioventricular From the Electrophysiology Laboratory and Pacemaker Center, S. Camillo Hospital, Rome, Italy. Manuscript received August 14, 1989; revised manuscript received and accepted November 27, 1989. Address for reprints: Massimo Santini. MD, Largo di Vigna Stelluti, 12, 00 19 1, Rome, Italy.
THE AMERICAN
JOURNAL
OF CARDIOLOGY
MARCH
15, 1990
729
TABLE
I Baseline Data for All Patients No CD
With CD Mean Follow-Up
Age
>70 yr (%)
570
>70
570 yr (%)
>70 yr (%)
570
>70
74 (55) 48 O-9 17 (21.5) 139 (41)
5.4 3.8 4.4
5.8 4.1 3.4
10 (8) 11(14) 21 (6.19) 67 (19.76)
31 (25) 15 (19) 46 (13.5)
4.6 5
3.6 4.1
Age Pacing Mode
No. Cases
570 yr (%)
AAI WI DDD Total
135 125 79 339
61 36 36 133
CD = conductmn
(45) (29) (45.5) (39.2) 272 (80.2)
r
100 100
p or 70 570
14/x1 -4/10 .I 3/15 o/11
451 461
M/41
>70 570
25/48 15/36
52 41 23.5
40/84
3/26
I (44) p 70 570 >70 570
AAI CD = conducton
4/17 3/36 2/74 3/61
8 2.7 4.9
(47.6) p
in Sick Sinus Syndrome Defects and Modes Cardiac Pacing
Massimo Santini, MD, Georgia Alexidou, MD, Gerard0 Ansalone, MD, Giuseppe Cacciatore, MD, Roberto Cini, MD, and Gioia Turitto, MD A large population of sick sinus syndrome (SSS) patients was analyzed to determine whether age of patients, presence of conduction disturbances and mode of permanent pacing are related to the occurrence of supraventricular tachyarrhythmias, cerebral embolism and cardiac mortality. Three hundred thirty-nine patients permanently paced (135 AAI, 79 DDD, 125 VW) because of SSS were followed for a mean period of 5 years (range 2 to 10). Patients were divided into 4 groups according to age (70 years) and the presence or absence of an associated conduction disturbance. Sixty-eight percent of VVI, 55% of AAI and 40.5% of DDD patients were >70 years of age. In the VVI and DDD groups a conduction disturbance was present in 67 of 204 (33%) patients; conduction disturbances were more common in patients >70 years old (46 of 111,41%) than in those 140 beats/min) remained unchanged during the follow-up period in 62% of AAI patients. In 9% of these patients, the Wenckebach threshold showed some degree of deterioration, but only in 2 patients was it 140 beats/min. The DDD mode was selected in the following 3 circumstances: the presence of atrioventricular block or intraventricular conduction disturbances; the absence of atrioventricular block or intraventricular conduction disturbances when atria1 pacing at rest induced type I second-degree atrioventricular From the Electrophysiology Laboratory and Pacemaker Center, S. Camillo Hospital, Rome, Italy. Manuscript received August 14, 1989; revised manuscript received and accepted November 27, 1989. Address for reprints: Massimo Santini. MD, Largo di Vigna Stelluti, 12, 00 19 1, Rome, Italy.
THE AMERICAN
JOURNAL
OF CARDIOLOGY
MARCH
15, 1990
729
TABLE
I Baseline Data for All Patients No CD
With CD Mean Follow-Up
Age
>70 yr (%)
570
>70
570 yr (%)
>70 yr (%)
570
>70
74 (55) 48 O-9 17 (21.5) 139 (41)
5.4 3.8 4.4
5.8 4.1 3.4
10 (8) 11(14) 21 (6.19) 67 (19.76)
31 (25) 15 (19) 46 (13.5)
4.6 5
3.6 4.1
Age Pacing Mode
No. Cases
570 yr (%)
AAI WI DDD Total
135 125 79 339
61 36 36 133
CD = conductmn
(45) (29) (45.5) (39.2) 272 (80.2)
r
100 100
p or 70 570
14/x1 -4/10 .I 3/15 o/11
451 461
M/41
>70 570
25/48 15/36
52 41 23.5
40/84
3/26
I (44) p 70 570 >70 570
AAI CD = conducton
4/17 3/36 2/74 3/61
8 2.7 4.9
(47.6) p
