Effectiveness of pacemaker treatment in the bradycardia-tachycardia syndrome

Conde, Cesar A.; Leppo, Jeffrey A.; Lipski, Janet; Stimmel, Barry; Litwak, Robert S.; Donoso, Ephraim; Dack, Simon

doi:10.1016/s0002-9149(73)80122-5

Cited by 63 publications

(13 citation statements)

References 33 publications

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“…However, though the incidence of ischaemic heart disease in sinoatrial disorder has been put as high as 71 per cent (Conde et al, 1973) and 61 per cent (Hartel and Talvensaari, 1975), it has also been reported as low as 14 per cent (Rokseth and Hatle, 1974), and 15 per cent (Fairfax et al, 1976). The results in the present survey appear to be in close agreement with the latter 2 studies in that a past history of myocardial infarction was found in just under 16 per cent of instances of established and potential sinoatrial disorder.…”

Section: Discussionsupporting

confidence: 88%

Potential candidates for pacemakers. Survey of heart block and sinoatrial disorder (sick sinus syndrome).

Shaw¹,

Kekwick²

1978

Heart

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SUMMARY Future pacemaker requirements in Britain are related to the incidence of heart block and sinoatrial disorder (sick sinus syndrome) in the community. This paper reports an 8-year survey of these conditions by direct approach to the general practitioners looking after approximately 600 000 people. The patients were divided into 4 non-exclusive groups (numbers of patients are in parentheses); chronic complete heart block (436), sinus bradycardia (potential and established sinoatrial disorder) (305), established sinoatrial disorder (131), and paced patients (209). Patients with sinoatrial disorder and sinus bradycardia were some 10 years younger than those with heart block and their prevalence tended to decline in the very old, whereas the prevalence of heart block continued to increase almost exponentially, exceeding 5 per 1000 in men aged 80 and above.Only a minority of patients gave a past history of cardiac infarction or diphtheria, but both conditions were commoner in sinoatrial disorder (16% and 14%, respectively) than in complete heart block (9% and 8%, respectively). A surprising finding was that men predominated in all groups, particularly in those with sinus bradycardia where the male:female ratio was 2-5:1. The annual number of new paced patients rose during the course of the survey, reaching 73 per million (per year) by the seventh and eighth years, but the annual incidence of conditions producing bradycardia and potentially requiring pacemaker therapy was still much greater at 159 to 174 per million of the population.In Britain the number of initial implantations of cardiac pacemakers has almost trebled since 1972 and it is predicted that there will be a further threefold increase in the next 5 years (Sowton, 1976). In view of this dramatic rise in the use of such expensive and sophisticated equipment it might be expected that the incidence and aetiology of the main conditions requiring pacemaking, namely heart block and sinoatrial disorder, would be well known, but in fact the lack of epidemiological data on heart block has been bewailed by Campbell as recently as 1977. Data on sinoatrial disorder are even more scarce (British Medical journal, 1977), while the problem is compounded by the absence of a clear-cut definition of the condition. In the past coronary artery disease was blamed for both chronic heart block and sinoatrial disorder, and if this were correct the current 'epidemic' of ischaemic heart disease should be followed by an increase in their

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Section: Discussionsupporting

confidence: 88%

Potential candidates for pacemakers. Survey of heart block and sinoatrial disorder (sick sinus syndrome).

Shaw¹,

Kekwick²

1978

Heart

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“…Normal function usually returns within a few days (Fluck et al, 1967), though authors reporting longterm follow-up of patients after infarction draw conflicting conclusions (Hatle et al, 1976;Parameswaran et al, 1976). Similarly the incidence of a past history of a myocardial infarct differs between series of cases with chronic sinoatrial disorder (Conde et al, 1973;Hartel and Tarvensaari, 1975;Shaw, 1976). In the few previous necropsy descriptions of patients dying with chronic sinoatrial disorder, several authors found arteriosclerosis of the coronary vasculature and thereby imply that ischaemia is the cause of the disturbance of sinus node and atrial function (Rosen et al, 1971;Kaplan et al, 1973;Kulbertus et al, 1973;Aroesty et al, 1974), but detailed investigations of the nodal blood supply had not been made, nor had post-mortem coronary angiography been performed.…”

Section: Discussionmentioning

confidence: 99%

Pathological studies in sinoatrial disorder (sick sinus syndrome).

Evans¹,

Shaw²

1977

Heart

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“…Acute dysfunction of the sinus node is commonly seen in the early stages of myocardial infarction but it usually disappears within the first 24-48 hours' and initially coronary artery disease was assumed to be responsible for most cases of chronic dysfunction. [2][3][4] More recently this has been disputed and the long term follow up of patients showing sinus node dysfunction in the acute phase of myocardial infarction has produced conflicting results.56 Currently necropsy studies have shown few major lesions of the blood vessels supplying the Requests for reprints to Dr David B Shaw, Cardiac Department, Royal Devon and Exeter Hospital (Wonford), Barrack Road, Exeter EX2 5DW. Accepted for publication 9 July 1987 sinus node,7 ' but the numbers of cases studied are small and even fewer have been investigated by postmortem angiography.…”

mentioning

confidence: 99%

Chronic sinoatrial disorder (sick sinus syndrome): a possible result of cardiac ischaemia.

Shaw

Linker

Heaver

et al. 1987

Heart

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Postmortem angiography was used to examine the blood vessels supplying the sinoatrial node in 25 subjects with chronic sinoatrial disorder (group 1). The results were compared with similar studies in 54 subjects who died of heart block and in whom sinus node function was normal (group 2). Although no significant lesion obstructing the blood flow to the sinus node was seen in the majority of those in group 1, there were abnormalities in seven cases, with reduced filling of the sinus node artery in five. In group 2 the sinus node artery filled normally in all cases despite major disease of the parent vessel in three. The combination of contralateral coronary artery disease with extensive atrial anastomoses was actively sought because this arrangement might predispose to a steal phenomenon. Such conditions were fully met in three cases in group 1 and two cases in group 2, and were found to a lesser extent in a further two cases in group 1 and three in group 2. Although coronary artery disease was unlikely to be the principal cause of sinus node dysfunction in most of the cases studied it was relatively common and may have been a factor in about one third. Improved survival after myocardial infarction may increase the number of patients with chronic sinoatrial disorder of ischaemic origin.

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Effectiveness of pacemaker treatment in the bradycardia-tachycardia syndrome

Cited by 63 publications

References 33 publications

Potential candidates for pacemakers. Survey of heart block and sinoatrial disorder (sick sinus syndrome).

Potential candidates for pacemakers. Survey of heart block and sinoatrial disorder (sick sinus syndrome).

Pathological studies in sinoatrial disorder (sick sinus syndrome).

Chronic sinoatrial disorder (sick sinus syndrome): a possible result of cardiac ischaemia.

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