Atrial Flutter and Sick Sinus Syndrome.

BACKGROUND

Sick sinus syndrome (SSS) is a common condition resulting in reduced quality of life, syncope, and pacemaker (PPM) implantation, but predictors have not been elucidated. While atrial arrhythmias are frequently associated with SSS, we hypothesized that atrial flutter (AFL) would strongly predict SSS given shared relationships with right atrial, and particularly crista terminalis, fibrosis.

OBJECTIVE

To assess the impact of AFL on the occurrence of SSS and associated syncope and PPM implantation.

METHODS

Healthcare databases were used to identify adults aged ≥ 18 years receiving hospital-based care in California in 2005-2019. ICD codes were used to identify diagnoses and procedures. Patients were classified based on the presence of AFL and atrial fibrillation (AF). Cox proportional hazard models adjusting for demographics and co-morbidities were employed.

RESULTS

We included 29,357,609 individuals (54% females, mean age 46 years), 101,243 with AFL alone, 1,674,680 with AF alone, and 284,547 with AF and AFL. After adjustment for age, sex, race and ethnicity, and co-morbidities, AF, AFL, and both arrhythmias were each associated with increased risk of SSS and associated syncope and PPM implantation (all p<0.001). In the population with AF, an additional AFL diagnosis conferred a higher risk of developing SSS (hazard ratio [HR]1.62, 95% confidence interval [CI] 1.59-1.64), syncope (HR 1.63, 1.54-1.72) and PPM implantation (HR 1.74, 1.70-1.79).

CONCLUSION

AFL is associated with an increased risk of incident SSS and its adverse consequences, especially in patients with co-existing AF. AFL may be useful for risk stratification strategies to predict, prevent, and treat SSS.

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.