Termination of Pacing in Patients with Sick Sinus Syndrome and Implanted Pacemakers who Developed Chronic Atrial Fibrillation

Summary

A significant number of patients (pts) with sick sinus syndrome (SSS) treated with implanted ventricular pacemakers (PM), develop consequently chronic atrial fibrillation (AF) which terminates their clinical syndrome. In these pts, termination of permanent pacing (PP) may be considered. Among a group of 100 pts with SSS, treated with implanted PMs, 27 pts (27%) developed chronic AF following implantation. Of this group, long-term PP was terminated in 10 pts. In 2 pts pacing was ceased unexpectedly as a result of PM or electrode malfunction. In 8 pts it was terminated intentionally as batteries exhausted and were not replaced. All 10 pts were asymptomatic when pacing was discontinued and have been followed closely since; their ages ranged from 53 to 80 years (mean 70) and the duration of PP before termination ranged between 12 to 76 months (mean 46). Follow-up period since termination of pacing ranged from 12 to 40 months (mean 30). In 5 pts PP had to be reinstituted (by replacing the PM): 3 became asymptomatic due to AF with slow ventricular rate and 2 had symptomatic recurrences of sinus of junctional bradycardia. The other 5 pts remained well and asymptomatic without PP. In conclusion, in some paced SSS pts who developed chronic AF, termination of PP is possible as AF is stable and the ventricular rate is adequate but in some, slow ventricular rate or unstable AF indicates the continuation of pacing.