title: Sinus Node Dysfunction Is Associated With Higher Symptom Burden and Increased Comorbid Illness: Results From the ORBIT-AF Registry.
abstract: BACKGROUND
  Patients with sinus node dysfunction (SND) have increased risk of atrial tachyarrhythmias, including atrial fibrillation (AF). To date, treatment patterns and outcomes of patients with SND and AF have not been well described.
  
  
  OBJECTIVE
  Patients with SND and AF have higher risk of adverse cardiovascular outcomes.
  
  
  METHODS
  Sinus node dysfunction was defined clinically, based on treating physician. Treatment patterns were described and logistic regression analysis performed to assess outcomes.
  
  
  RESULTS
  Overall, 1710 (17.7%) out of 9631 patients had SND at enrollment. Patients with SND and AF had increased comorbid medical illnesses, more severe symptoms (European Heart Rhythm Association class IV: 17.5% vs 13.9%; P = 0.0007), and poorer quality of life (median 12-month Atrial Fibrillation Effect on Quality of Life score: 79.6 vs 85.2; P = 0.0008). There were no differences in AF management strategy between patients with SND and those without (rate control, 69.7% vs 67.7%; rhythm control, 30.0% vs 32.0%; P = 0.11). After adjustment, patients with SND were more likely than those without SND to progress from paroxysmal AF at baseline to persistent or permanent AF at any follow-up, or persistent AF at baseline to permanent AF at any follow-up (odds ratio: 1.23, 95% confidence interval: 1.01-1.49, P = 0.035). However, there was no association between SND and major risk-adjusted outcomes.
  
  
  CONCLUSIONS
  Sinus node dysfunction is present in 1 of 6 patients with AF and is associated with increased comorbidities and higher symptom burden. However, SND is not associated with an increase in major risk-adjusted outcomes.
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Larry R
authors.initials: LR
authors.lastname: Jackson
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Sung Hee
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
authors.affiliation: Mayo Clinic College of Medicine, Division of Cardiovascular Medicine, Rochester, Minnesota.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.affiliation: Penn State University School of Medicine, Division of Cardiovascular Medicine, Hershey, Pennsylvania.
authors.forename: Gerald V
authors.initials: GV
authors.lastname: Naccarelli
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: James A
authors.initials: JA
authors.lastname: Reiffel
authors.affiliation: Yale University School of Medicine, Division of Cardiovascular Medicine, New Haven, Connecticut.
authors.forename: James
authors.initials: J
authors.lastname: Freeman
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Laine
authors.initials: L
authors.lastname: Thomas
authors.affiliation: Janssen Pharmaceuticals, Inc., Division of Internal Medicine, Raritan, New Jersey.
authors.forename: Paul
authors.initials: P
authors.lastname: Chang
authors.affiliation: Division of Cardiology, University of California Los Angeles, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Kaiser Permanente, Kaiser Permanente Division of Research, Oakland, California.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Lankenau Institute for Medical Research, Jefferson Medical College, Wynnewood, Pennsylvania.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Kowey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D016009:Chi-Square Distribution; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012804:Sick Sinus Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology