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Heart 1999;81:412-418; doi:10.1136/hrt.81.4.412
Copyright © 1999 BMJ Publishing Group Ltd & British Cardiovascular Society
Heart 1999;81:412-418 ( April )

Arterial thromboembolism in patients with sick sinus syndrome: prediction from pacing mode, atrial fibrillation, and echocardiographic findings

H R Andersen, J C Nielsen, P E B Thomsen, L Thuesen, A K Pedersen, P T Mortensen, T Vesterlund

Department of Cardiology, Skejby Sygehus, Aarhus University Hospital, 8200 Aarhus N, Denmark

Correspondence to: Dr Andersen.

Accepted for publication 25 November 1998

OBJECTIVE---To evaluate whether thromboembolism in sick sinus syndrome can be predicted by pacing mode, atrial fibrillation, or echocardiographic findings.
METHODS---Patients were randomised to single chamber atrial (n = 110) or ventricular (n = 115) pacing. They were divided into subgroups with and without brady-tachy syndrome at time of randomisation. The occurrence of atrial fibrillation and thromboembolism during follow up were investigated and compared with echocardiographic findings.
RESULTS---The annual risk of thromboembolism was 5.8% in patients with brady-tachy syndrome randomised to ventricular pacing, 3.2% in patients without brady-tachy syndrome randomised to ventricular pacing, 3% in patients with brady-tachy syndrome randomised to atrial pacing, and 1.5% in patients without brady-tachy syndrome randomised to atrial pacing. In atrial paced patients without brady-tachy syndrome at randomisation and without atrial fibrillation during follow up, the annual risk of thromboembolism was 1.4%. Left atrial size measured by M mode echocardiography was of no value in predicting thromboembolism.
CONCLUSIONS---Arterial thromboembolism in patients with sick sinus syndrome is very common and is associated primarily with brady-tachy syndrome at randomisation and with ventricular pacing. The risk of thromboembolism is small in atrial paced patients in whom atrial fibrillation has never been documented.

Keywords: sick sinus syndrome; atrial pacing; atrial fibrillation; thromboembolism

© 1999 by Heart
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