Prognosis of Patients Permanently Paced for Sick Sinus Syndrome

Age, sex, and ischaemic heart disease as prognostic indicators in long-term cardiac pacing.

“…gests an improvement on the natural prognosis (Cosby et at., 1966;Edhag and Swahn, 1976). The inclusion of some patients (6% of those paced) with sinuatrial disorder is unlikely to have improved the prognosis of the study group as a whole (Wohl et al, 1976;Shaw et al, 1978). Neither is the initial use of asynchronous generators likely to have had a statistically significant effect on survival (Siddons, 1974) though 'demand' systems are now preferred because of the frequency of emergent, potentially competitive, rhythms even in those apparently in stable, complete heart block at the time of generator implantation (Grover et al, 1974;Furman and Fisher, 1977).…”

The Unbalanced Heart

“…In the management of this syndrome, electrical pacing seemed to offer logical therapeutic benefits and has produced temporary relief. Unfortunately, the initial benefits have failed to eliminate a formidable mortality: 42% within 25 months in one series and 33% within an average of 17.9 months survival in another series (11,29). Furthermore, electrical pacing has failed to control the syncope resulting from tachydysrhythmias even though it does allow more vigorous application of antiarrhythmic drugs by reducing the risk that occurs without its protection.…”

Which Pacemaker?

“…Controversy persists concerning pacemaker therapy for symptomatic patients with bi‐ or trifascicular block (bifascicular refers to right bundle branch block with either left anterior or left posterior fascicular block; trifascicular describes the above condition when associated with first‐degree heart block). Such patients have a poor five‐year prognosis, and are at increased risk of sudden death 12 . This was thought to be due to progression to complete AV block.…”

“…However, VVI mode (ventricular demand) pacing does not influence overall mortality in this syndrome 10 , 11 . Patients with severe sinus node dysfunction (marked sinus pauses and/or the bradycardia‐tachycardia syndrome) have a relatively poor prognosis with a five‐year mortality of up to 40% 12 . In contrast, patients with recurrent bradycardia alone have a similar 15‐year survival to that of an age‐matched population without bradyarrhythmias 13 .…”