The Dynamic Relationship Among Atrial Pacing, Premature Atrial Beats, Mode Switching, and Atrial High-Rate Episodes in Patients with Sick Sinus Syndrome
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The Dynamic Relationship Among Atrial Pacing, Premature Atrial Beats, Mode Switching, and Atrial High-Rate Episodes in Patients with Sick Sinus Syndrome

1. University of Health Sciences Turkey, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Clinic of Cardiology, İstanbul, Turkey
2. Osmaniye State Hospital, Clinic of Cardiology, Osmaniye, Turkey
No information available.
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Received Date: 21.09.2024
Accepted Date: 13.01.2025
Online Date: 27.01.2025
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Abstract

Objectives: This study aimed to explore the association between atrial pacing percentage, frequency of premature atrial beats, and mode-switch episodes and the occurrence of atrial high-rate episodes (AHREs) in patients with sick sinus syndrome (SSS) who underwent dual-chamber pacemaker (DDDR) implantation.

Materials and Methods: This prospective, single-center, observational study included 60 patients with SSS and Medtronic DDDR pacemakers. Patients with pre-existing atrial fibrillation, ischemic stroke, heart failure, chronic renal failure, or insufficient follow-up data were excluded. Key parameters, such as atrial pacing percentage, premature atrial beats, mode-switch episodes, and AHREs, were evaluated at 1, 3, and 6 months and at 1 and 2 years after implantation.

Results: The mean age of the participants was 65.5 years, with 53.3% of them being male. During the first 3 months, atrial pacing percentage showed an inverse correlation with AHREs (83.7±19.8% at 1 month and 85.2±19.9% at 3 months; p=0.026 and p=0.046, respectively). mode-switch episodes and premature atrial beats were significantly associated with AHREs within the first 6 months (mode-switch episodes: 11.2±4.3 at 1 month, 11.4±3.2 at 3 months, and 6.7±3.1 at 6 months; p=0.015, p=0.033, p=0.041; premature atrial beats: 6.8±2.3% at 1 month, 7.1±2.1% at 3 months, and 7.2±1.9% at 6 months; p=0.015, p=0.022, p=0.031). AHRE prevalence increased progressively from 9.7±2.3% at 1 month to 18.1±4.1% at 3 months and 23.3±5.9% at 6 months. However, these associations diminished after 6 months, persisting less significantly at 1 and 2 years. Receiver operating characteristic curve analysis determined a 94.5% atrial pacing percentage cut-off at 1 month, with a sensitivity of 68% and specificity of 82% [area under the curve (AUC): 0.806, p<0.001], and a 94% cut-off at 3 months, with sensitivity and specificity of 68% and 90%, respectively (AUC: 0.801, p<0.001). For mode-switch episodes, a 1.5 cut-off value at both 1 and 3 months yielded sensitivities of 73% and 74% and specificities of 99% and 98%, respectively (AUC: 0.890 and 0.895, p<0.001).

Conclusion: This study highlights a time-dependent relationship between pacing parameters and AHREs in patients with SSS. The early post-implantation periods showed significant correlations, which diminished over time. These findings underscore the importance of regular monitoring for optimal management of SSS patients with DDDR pacemakers.

Keywords:
Atrial high-rate episodes, sick sinus syndrome, atrial pacing, atrial premature beat, mode switch episodes