title: [Auricular fibrillation and stroke in patients with sick sinus syndromeusing permanent pacemakers].
abstract: OBJECTIVE
  Since physiological pacing systems have become available, a debate has raged about the merits of atrial versus ventricular pacing in the sick sinus syndrome. The goal of this retrospective report was to study the long term incidence and the independent predictors for atrial fibrillation and stroke in 153 paced patients with sick sinus syndrome, adjusting for differences in baseline clinical variables with multivariate analysis.
  
  
  RESULTS
  From 1980 to 1994, we implanted 32 dualchamber, 33 atrial, and 88 ventricular pacemakers to treat patients with sick sinus syndrome. After a maximum follow-up of 177 months (median 30 months for paroxismal atrial fibrillation, 45 months for chronic atrial fibrillation and 43,5 months for stroke) the actuarial incidence of paroximal atrial fibrillation was 7.8% at 1 year, 29% at 5 years and 42% at 10 years. The actuarial incidence of chronic atrial fibrillation was 1.3% at 1 year, 9.8% at 5 years and 22% at 10 years. Independent predictors for paroxismal AF from Cox's model was history of atrial tachyarrhythmias (p < 0.0001), chronic obstructive pulmonary disease (p = 0,006) and age (> 70 years-old) (p = 0.035). Only a history of atrial tachyarrhythmias before pacemaker implant was an independent predictor for chronic atrial fibrillation (p < 0.0001). The odd ratio for paroxismal atrial fibrillation in patients with previous atrial tachyarrhythmias and chronic atrial fibrillation were 6 (2.8-12) and 4 (1.6-9.7) (95% confiance limits). Actuarial incidence of stroke was 3% at 1 year, 10% at 5 years and 14% at 10 years. Independent predictors for stroke were history of peripheral vascular disease (p = 0.033) and hypertensive cardiomyopathy (p = 0.015). Development of paroxysmal and chronic atrial fibrillation during the follow-up were higher in patients with stroke (p < 0.001 and p < 0.05).
  
  
  CONCLUSIONS
  Development of atrial fibrillation and stroke in paced patients with sick sinus syndrome are strongly determined by clinical variables. Preimplant paroxysmal atrial tachyarrhythmias is the most important predictor for atrial fibrillation in the follow-up.
authors: Unidad Coronaria, Hospital Clínico Universitario, Valencia.
authors: R
authors: R
authors: Sanjuán Máñez
authors: S
authors: S
authors: Morell Cabedo
authors: R
authors: R
authors: Ruiz Granell
authors: J
authors: J
authors: Cortina Nicolás
authors: M
authors: M
authors: Ibáñez Candela
authors: J V
authors: JV
authors: Monmeneu Menadas
authors: M
authors: M
authors: Blasco Cortés
authors: R
authors: R
authors: García Civera
authors: S
authors: S
authors: Botella Solana
mesh_terms: D000206:Actuarial Analysis; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D012804:Sick Sinus Syndrome / Q000150:complications / Q000628:therapy*
vernacular_title: Fibrilación auricular y accidente vascular encefálico en pacientes con enfermedad del nodo sinusal portadores de marcapasos definitivos.