LONG-TERM SURVIVAL AFTER PERMANENT PACEMAKER IMPLANTATION FOR SICK SINUS SYNDROME

In this population-based study, long-term survival and prognostic fact ors were examined in 148 patients, 55 men and 93 women, from olmsted C ounty, Minnesota, who had permanent pacemaker implantation for sick si nus syndrome between 1969 and 1991. The overall survival for patients who had received a permanent pacemaker for sick sinus syndrome was sig nificantly worse than that of an age and sex-matched control populatio n (p <0.0001). The increased mortality was attributable at least in pa rt to the presence of structural heart disease in patients with sick s inus syndrome who had undergone permanent pacemaker implantation (82 o f 148 patients, 55%). Survival of patients with isolated sick sinus sy ndrome was comparable (p = 0.6729), whereas in patients with structura l heart disease it was significantly worse than expected (p <0.0001). Symptoms were eliminated or improved in 116 patients (78%) after pacem aker implantation. Multivariate analysis identified congestive heart f ailure, valvular heart disease, history of stroke or transient ischemi c attack and age as independent risk factors for mortality. However, t here was a trend toward decreased survival in patients who had receive d ventricular pacing compared with those who had received dual-chamber pacing, but this difference did not reach statistical significance (p = 0.0556). The mode of pacing was not an independent risk factor (p = 0.23). The observed survival of patients aged <80 years was significa ntly worse than expected (p <0.0001), whereas that of patients aged gr eater than or equal to 80 years was similar to the expected (p = 0.22) .