Prevalence and predictors of atrial arrhythmias in patients with sinus node dysfunction and atrial pacing

  • Abdallah Bukari
  • Eisha Wali
  • Amrish Deshmukh
  • Zaid Aziz
  • Michael Broman
  • Andrew Beaser
  • Gaurav Upadhyay
  • Hemal Nayak
  • Roderick Tung
  • Cevher OzcanEmail author



This study aimed to determine the incidence, prevalence, and predictors of atrial arrhythmias (AAs) in patients with symptomatic sinus node dysfunction (SND) who required permanent pacemaker implantation. Also, we evaluated the impact of atrial pacing (AP) on AAs.


All consecutive patients who underwent pacemaker implantation from 2005 to 2011 were included. Atrial fibrillation (AF), atrial flutter (AFL), atrial tachycardia (AT), and AV nodal reentrant tachycardia (AVNRT) were detected via pacemaker interrogation and clinical documentation.


The study group included 322 patients (44% male) with mean age 68.8 ± 15 years and followed for an average of 5.6 ± 2.2 years (median 5.7 years). Overall, 61.8% were found to have any AA at follow-up. Individual prevalence of AAs was high as follows: AF 43.5%, AFL 6.5%, AT 25%, and AVNRT 6.8%. AF was documented in 23% of patients (n = 74) prior to pacemaker; among those, 15% (n = 11) had no recurrence of AF with average AP of 74%. The incidence of new-onset AF after pacemaker was 15.8%. In subgroup analysis, prevalence of AF was increased by 16% with high rate of AP (81–100%) and 17% with lower rate of AP (0–20%). Incidence of new-onset AF was not affected by AP. Diabetes, hypertension, and left atrial enlargement were predictors of AAs. White men and women had higher prevalence of AF.


AAs are highly prevalent in SND, particularly in white patients. Paroxysmal AF is suppressed with AP in minority, but there is no impact of AP on new-onset AF. Patients with diabetes, hypertension, and dilated atria must be monitored closely for early detection of AAs.


Pacemaker Atrial arrhythmias Atrial fibrillation Sinus node dysfunction 


Funding source

C. Ozcan is supported by the National Institutes of Health/NHLBI (1K08HL117082-01A4).


  1. 1.
    Jensen PN, Gronroos NN, Chen LY, Folsom AR, DeFilippi C, Heckbert SR, et al. Incidence of and risk factors for sick sinus syndrome in the general population. J Am Coll Cardiol. 2014;64:531–8.CrossRefGoogle Scholar
  2. 2.
    Gillis AM, Morck M. Atrial fibrillation after DDDR pacemaker implantation. J Cardiovasc Electrophysiol. 2002;13:542–7.CrossRefGoogle Scholar
  3. 3.
    John RM, Kumar S. Sinus node and atrial arrhythmias. Circulation. 2016;133:1892–900.CrossRefGoogle Scholar
  4. 4.
    Healey JS, Toff WD, Lamas GA, Andersen HR, Thorpe KE, Ellenbogen KA, et al. Cardiovascular outcomes with atrial-based pacing compared with ventricular pacing: meta-analysis of randomized trials, using individual patient data. Circulation. 2006;114:11–7.CrossRefGoogle Scholar
  5. 5.
    Lamas GA, Lee KL, Sweeney MO, Silverman R, Leon A, Yee R, et al. Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. N Engl J Med. 2002;346:1854–62.Google Scholar
  6. 6.
    Said S, Cooper CJ, Alkhateeb H, Gosavi S, Dwivedi A, Onate E, et al. Incidence of new onset atrial fibrillation in patients with permanent pacemakers and the relation to the pacing mode. Med Sci Monit. 2014;20:268–73.CrossRefGoogle Scholar
  7. 7.
    Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, et al. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2016;67:e27–e115.CrossRefGoogle Scholar
  8. 8.
    January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC, et al. AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014;2014(130):e199–267.Google Scholar
  9. 9.
    Benjamin EJ, Levy D, Vaziri SM, D’Agostino RB, Berlanger A, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort: the Framingham Heart Study. JAMA. 1994;271:840–4.CrossRefGoogle Scholar
  10. 10.
    Gupta DK, Shah AM, Giugliano RP, Ruff CT, Antman EM, Grip LT, Deenadayalu N, Hoffman E, Patel I, Shi M, Mercuri M, Mitrovic V, Braunwald E, Solomon SD, for the Effective aNticoaGulation with factor xA next GEneration in AF-Thrombolysis In Myocardial Infarction 48 (ENGAGE AF-TIMI 48) Echocardiographic Study Investigators Left atrial structure and function in atrial fibrillation: ENGAGE AF-TIMI 48. Eur Heart J 2014; 35:1457–1465.Google Scholar
  11. 11.
    Healey JS, Martin JL, Duncan A, Connolly SJ, Ha AH, Morillo CA, et al. Pacemaker-detected atrial fibrillation in patients with pacemakers: prevalence, predictors, and current use of oral anticoagulation. Can J Cardiol. 2013;29:224–8.CrossRefGoogle Scholar
  12. 12.
    Tse HF, Lau CP. Prevalence and clinical implications of atrial fibrillation episodes detected by pacemaker in patients with sick sinus syndrome. Heart. 2005;91:362–4.CrossRefGoogle Scholar
  13. 13.
    Defaye P, Dournaux F, Mouton E. Prevalence of supraventricular arrhythmias from the automated analysis of data stored in the DDD pacemakers of 617 patients: the AIDA study. Pacing Clin Electrophysiol. 1998;21:250–5.CrossRefGoogle Scholar
  14. 14.
    Horvath G, Goldberger JJ, Kadish AH. Simultaneous occurrence of atrial fibrillation and atrial flutter. J Cardiovasc Electrophysiol. 2000;11:849–58.CrossRefGoogle Scholar
  15. 15.
    Waldo AL, Feld GK. Inter-relationships of atrial fibrillation and atrial flutter. Mechanisms and Clinical Implications. J Am Coll Cardiol. 2008;51:779–86.CrossRefGoogle Scholar
  16. 16.
    Vaziri SM, Larson MG, Benjamin EJ, Levy D. Echocardiographic predictors of nonrheumatic atrial fibrillation: the Framingham Heart Study. Circulation. 1994;89:724–30.CrossRefGoogle Scholar
  17. 17.
    Kamel H, Kleindorfer DO, Bhave PD, Cushman M, Levitan EB, Howard G, et al. Rates of atrial fibrillation in black versus white patients with pacemakers. J Am Heart Assoc. 2016;5:1–7.CrossRefGoogle Scholar
  18. 18.
    Alonso A, Agarwal SK, Soliman EZ, Ambrose M, Chamberlain AM, Prineas RJ, et al. Incidence of atrial fibrillation in whites and African-Americans: the Atherosclerosis Risk in Communities (ARIC) study. Am Heart J. 2009;158:111–7.CrossRefGoogle Scholar
  19. 19.
    Hjortshøj S, Riahi S, Nielsen JC, Skjøth F, Lundbye-Christensen S, Andersen HR. Does atrial pacing lead to atrial fibrillation in patients with sick sinus syndrome? Insights from the DANPACE trial. Europace. 2014;16:241–5.CrossRefGoogle Scholar
  20. 20.
    Elkayam L, Koehler J, Sheldon T, Glotzer T, Rosenthal L, Lamas G. The influence of atrial and ventricular pacing on the incidence of atrial fibrillation: a meta-analysis. PACE. 2011;34:1593–9.CrossRefGoogle Scholar
  21. 21.
    Monfredi O, Boyett MR. Sick sinus syndrome and atrial fibrillation in older persons — a view from the sinoatrial nodal myocyte. J Mol Cell Cardiol. 2015;83:88–100.CrossRefGoogle Scholar
  22. 22.
    Inohara T, Shrader P, Pieper K, Blanco R, Thomas L, Singer D, et al. Association of atrial fibrillation clinical phenotypes with treatment patterns and outcomes. JAMA Cardiol. 2018;3:54–63.CrossRefGoogle Scholar
  23. 23.
    Chen Y, Bai R, Lin T, Salim M, Sang C, Long D, et al. Pacing or ablation: which is better for paroxysmal atrial fibrillation-related tachycardia-bradycardia syndrome? Pacing Clin Electrophysiol. 2014;37:403–11.CrossRefGoogle Scholar
  24. 24.
    Khaykin Y, Marrouche N, Martin D, Saliba W, Schweikert R, Wexman M, et al. Pulmonary vein isolation for atrial fibrillation in patients with symptomatic sinus bradycardia or pauses. J Cardiovasc Electrophysiol. 2004;15:784–9.CrossRefGoogle Scholar
  25. 25.
    Hocini M, Sanders P, Deisenhofer I, Jaïs P, Hsu LF, Scavée C, et al. Reverse remodeling of sinus node function after catheter ablation of atrial fibrillation in patients with prolonged sinus pauses. Circulation. 2003;108:1172–5.CrossRefGoogle Scholar
  26. 26.
    Jackson LR, Rathakrishnan B, Campbell K, Thomas KL, Piccini JP, Bahnson T, et al. Sinus node dysfunction and atrial fibrillation: a reversible phenomenon? PACE. 2017;40:442–50.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Abdallah Bukari
    • 1
  • Eisha Wali
    • 1
  • Amrish Deshmukh
    • 1
  • Zaid Aziz
    • 1
  • Michael Broman
    • 1
  • Andrew Beaser
    • 1
  • Gaurav Upadhyay
    • 1
  • Hemal Nayak
    • 1
  • Roderick Tung
    • 1
  • Cevher Ozcan
    • 1
    Email author
  1. 1.Department of Medicine, Section of Cardiology, Center for Arrhythmia Care, Heart and Vascular CenterUniversity of Chicago Medicine Pritzker School of MedicineChicagoUSA

Personalised recommendations