Rt. Tung et al., LONG-TERM SURVIVAL AFTER PERMANENT PACEMAKER IMPLANTATION FOR SICK SINUS SYNDROME, The American journal of cardiology, 74(10), 1994, pp. 1016-1020
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)
.