Background: Currently, bradycardia treatment is limited to permanent pacemaker (PM) implantation. No consensus exists as to its optimal medication regimen. However, as cilostazol accelerates heart rate (HR) in bradycardia, we investigated its efficacy for sick sinus syndrome (SSS) to avoid permanent PM implantation. Methods: This was a retrospective, case-control study. We included 192 consecutive patients diagnosed with SSS (after applying some exclusion criteria), of whom 54 received cilostazol (cilostazol group) and 138 did not receive cilostazol (control group). The primary endpoint was the PM implantation rate after 6 months; secondary endpoints were 1-and 3-month PM implantation rates, HR after 1 week, 1 and 6 months, and cilostazol side effects. Results: The 6-month PM implantation rate was lower in the cilostazol than the control group (20.4% vs. 55.8%, respectively; p < 0.001). In multivariate analysis, cilostazol decreased the 6-month PM implantation rate (OR: 0.22; 95% CI: 0.08-0.55; p = 0.001). Although baseline HR was significantly lower in the cilostazol group, HR in this group increased and did not significantly differ between the two groups after 1 week, 1 and 6 months. In subgroup analyses of symptomatic patients, the PM implantation rates after 6 months were significantly lower in the cilostazol group than in the control group. Conclusions: Cilostazol was effective for symptomatic SSS to avoid PM implantation by increasing HR.

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