The Natural History of Sick Sinus Syndrome

Sutton, Richard; Kenny, Rose Anne

doi:10.1111/j.1540-8159.1986.tb06678.x

Cited by 264 publications

(58 citation statements)

References 39 publications

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“…8-10,15-18) Ventricular demand pacing precipitates chronic atrial fibrillation, cerebral vascular accidents and CHF.15) In patients paced for sick sinus syndrome chronic AF was significantly Jpn Heart J September 1994 lower in those paced in the atrial demand or AV sequential mode than those paced in the ventricular demand mode. 11,14,16,17,[19][20][21] This difference was more evident when comparison was made in patients with documented atrial tachyrhythmia before implantation. Considering the high incidence of AF in the natural course of sick sinus syndrome,9) atrial pacing was proposed to reduce the possibility of this untoward entity, especially in those with bradycardia-dependent atrial tachyrhythmias.22) Two of our patients who presented with PAY before implantation did not develop atrial fibrillation later during follow-up.…”

Section: Discussionmentioning

confidence: 97%

Atrial Demand Pacing in Patients with Symptomatic Sick Sinus Syndrome.

Lee¹,

Kong²,

Wang³

et al. 1994

Jpn Heart J

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Section: Discussionmentioning

confidence: 97%

Atrial Demand Pacing in Patients with Symptomatic Sick Sinus Syndrome.

Lee¹,

Kong²,

Wang³

et al. 1994

Jpn Heart J

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“…The results of many prospective and retrospective studies have shown significant antiarrhythmic effects. [12][13][14][15][16][17][18][19][20][21] Nonetheless, some patients require relatively faster atrial pacing at a rate of 90 beats/min, which may be poorly tolerated on a long-term basis. [22][23] Basic rate programming does not usually allow atrial pacing percentages higher than 80%.…”

Section: Discussionmentioning

confidence: 99%

Effects of Right Atrial Pacing Preference in Prevention of Paroxysmal Atrial Fibrillation

Ogawa

Ishikawa

Matsushita

et al. 2008

Circ J

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trial fibrillation (AF) occurs as a result of various mechanisms. 1 The initiating mechanisms of AF are considered to be bradycardia, that is, premature atrial contraction (PAC). Pharmacological treatment by class I or III antiarrhythmic drugs is usually effective. 2-3 Nonetheless, some patients are refractory to antiarrhythmic agents. Atrial pacing has been shown to prevent paroxysmal AF. [4][5][6][7] Overdrive atrial pacing is thought to prevent AF triggered by bradycardia and premature atrial beats. The Atrial Pacing Preference™ (APP; Guidant, St Paul, MN, USA) algorithm allows the pacemaker to maintain a pacing rate slightly higher than the sinus rate. However, the efficacy and optimal setting of APP are unclear. The present multicenter study evaluates the efficacy of APP for the prevention of AF and the importance of optimal APP search interval setting in patients with sick sinus syndrome (SSS) and AF. Methods Patient SelectionThe inclusion criteria were those of the American College of Cardiology/American Heart Association class I or II pacemaker indications, together with a history of paroxysmal episodes of AF. Each patient underwent implantation of 2 permanent pacing leads. RA leads were placed at the RA appendage, and RV leads were placed at the RV apex. The exclusion criteria were: presence of chronic AF, <20 years old, pregnancy, undergoing dialysis, chronic renal failure, and severe heart failure. Antiarrhythmic drug therapy remained essentially unchanged in all patients. Written informed consent was obtained from all patients. The local ethics committee approved the study. Device CharacteristicsAll patients received a Model 1280™ (Guidant) combined with bipolar atrial and ventricular pacing leads. The device features included DDDR pacing and DDIR mode switch during atrial tachyarrhythmias and APP algorithm. The APP algorithm allows the pacemaker to maintain a pacing rate slightly higher than the sinus rate. When a Pwave is detected, the next pacing interval is shortened by 8 ms. When the pacing state is maintained for search intervals (ie, 2-128 programmable cycles), the pacing interval is prolonged by 8 ms. The APP pacing rate is limited to the Circ J 2008; 72: 700 -704 (Received July 22, 2007; revised manuscript received November 19, 2007; accepted December 11, 2007 Background Several preliminary studies have indicated that atrial pacing can prevent atrial tachyarrhythmias. The suggested mechanisms by which pacing may be effective include suppression of premature atrial beats. Methods and ResultsThe Atrial Pacing Preference™ (APP; Guidant, St Paul, MN, USA) algorithm allows the pacemaker to maintain a pacing rate slightly higher than the sinus rate. The preventive effects of APP on paroxysmal atrial fibrillation (AF) were studied in 51 patients (70±11 years). Nine patients did not complete the protocol. The pacemaker was programmed in random order to APP off and APP on at 3 different settings (ie, 8, 16 and 32 cycles) for 4 weeks each, using a cross-over design. Percentage atrial pacing was lower...

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“…Patients with sick sinus syndrome (SSS) managed by atrial pacing (AAI) had lower rates of atrial fibrillation [1][2][3][4], arterial thromboembolism [1][2][3], and mortality [1,[3][4][5] compared with those treated by ventricular pacing (VVI). It was also reported that patients with SSS benefited more from dual-chamber pacing (DDD) than from VVI [6][7][8].…”

Section: Streszczeniementioning

confidence: 99%

AAI – the forgotten pacing mode

Domagała¹,

Polewczyk²,

Zandecki³

et al. 2017

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For a long time the AAI pacing mode was commonly used in patients with sick sinus syndrome, who were treated with pacemaker. After the guideline recommendations were updated in 2013 the AAI mode was displaced by the DDDR mode, especially with atrioventricular delay management. The most important argument for this change was the risk of the development of advanced atrioventricular block in long-term observation. This situation may require changing the pacing mode to DDD and implanting a ventricular lead. However, the AAI pacing mode has many forgotten advantages and it could still be successfully used in well selected patients with sick sinus syndrome. StreszczeniePrzez wiele lat tryb stymulacji AAI był powszechnie używany u pacjentów z zespołem chorej zatoki, którzy wymagali implantacji kardiostymulatora. Po zmianie wytycznych w 2013 r. rozruszniki AAI zostały niemal całkowicie wyparte przez DDD, zwłaszcza z programowanym czasem opóźnienia przedsionkowo-komorowego. Argumentem za taką zmianą postępowania było głównie ryzyko rozwoju zaawansowanego bloku przedsionkowo-komorowego w długoterminowej obserwacji. Taka sytuacja może skutkować koniecznością zmiany trybu stymulacji, a co za tym idzie -koniecznością implantacji elektrody komorowej. Należy jednak pamiętać, że stymulacja w trybie AAI ma także wiele zapomnianych korzyści, które powodują, że nadal może ona być z powodzeniem stosowana w dobrze dobranej grupie pacjentów z objawową chorobą węzła zatokowego.

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The Natural History of Sick Sinus Syndrome

Cited by 264 publications

References 39 publications

Atrial Demand Pacing in Patients with Symptomatic Sick Sinus Syndrome.

Atrial Demand Pacing in Patients with Symptomatic Sick Sinus Syndrome.

Effects of Right Atrial Pacing Preference in Prevention of Paroxysmal Atrial Fibrillation

AAI – the forgotten pacing mode

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