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Original research article
Very long-term prognosis in patients with right ventricular apical pacing for sick sinus syndrome
  1. Kosuke Nakasuka1,2,
  2. Kohei Ishibashi1,
  3. Ayako Kamijima3,
  4. Tsukasa Kamakura1,
  5. Mitsuru Wada1,
  6. Yuko Inoue1,
  7. Koji Miyamoto1,
  8. Hideo Okamura1,
  9. Satoshi Nagase1,
  10. Takashi Noda1,
  11. Takeshi Aiba1,
  12. Satoshi Yasuda1,
  13. Nobuyuki Ohte2,
  14. Kengo Kusano1
  1. 1 Department of Cardiovascular Medicine, Natonal Cerebral and Cardiovascular Center, Suita, Japan
  2. 2 Department of Cardiorenal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
  3. 3 Department of Cardiology, Iida Municipal Hospital, Iida, Nagano, Japan
  1. Correspondence to Dr Kosuke Nakasuka; kosuke.nakasuka{at}, knakasuk{at}


Objective The impact of right ventricular (RV) apical pacing on very long-term cardiac prognosis is little known. In this study, we retrospectively evaluated the relationship between RV apical pacing and cardiovascular events (CEs) in patients with sick sinus syndrome (SSS) and left ventricular ejection fraction (LVEF) >35%.

Methods Total of 532 consecutive pacemaker recipients with SSS and LVEF >35% were divided into two groups according to the mean cumulative per cent RV apical ventricular pacing (mean %VP) (<50%; non-VP group vs ≥50%; VP group) and occurrence of CE was compared using Kaplan-Meier analysis between two groups. Cox hazard model was used to assess predictors of CE after adjusting explanatory variables such as age, atrial fibrillation (AF) and structural heart disease (SHD).

Results Mean %VP was 86.0% and 8.2% in VP and non-VP groups, respectively (p<0.001). During mean follow-up of 13.4±7.0 years, CE occurred in 131 patients and more frequently in VP than non-VP group (p<0.001). However, the VP group was no longer associated with CE after taking into account other variables in multivariate analysis, which revealed AF (HR (HR)=2.08), SHD (HR=4.97), low LVEF (HR=0.98 for every 1% increase) and high age (HR=1.03 for every year of age) were independent predictors for CE. Regarding patients with SHD and/or AF and those aged ≥75 years, Kaplan-Meier curves showed both groups had similar prognosis.

Conclusions Cardiac prognosis of patients with RV apical pacing was poor, but after adjusting for other predictors of CE, RV apical pacing was not a prognostic factor in patients with SSS with LVEF >35%.

  • pacemakers
  • bradyarrhythmias
  • atrial fibrillation

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  • Contributors KN has been working on this project and has done an outstanding job mainly developing this study. KI and AK: assisted in data collection for constructing the large database. All co-authors have read and approved the submission of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval This study was approved by the institutional review committee of the National Cerebral and Cardiovascular Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.