Bradycardia-Tachycardia Syndrome: Results In Twenty-eight Patients Treated by Combined Pharmacologic Therapy and Pacemaker Implantation

Abstract

The bradycardia-tachycardia syndrome was treated with pacemaker implantation and drugs in 28 patients. All patients survived pacemaker implantation and 26 of 28 patients experienced good control of their arrhythmias. Nineteen patients survived for more than one year (group 1); nine patients survived for less than one year (group 2), including two patients whose arrhythmias were not well controlled by pacemaker plus drugs. There was no significant difference in mean age between the two groups (75 ± 5 years in group 1 and 79 ± 3 years in group 2). Gout, diabetes, hypertension, angina pectoris, and cardiomegaly were equally common in both groups. Prior to implantation, 14 of 19 patients in group 1 were in NYHA class 1–2; 8 of 9 patients in group 2 were in NYHA class 3–4. Generally, the clinical classification of cardiac status was not changed by treatment. Myocardial infarction, ventricular tachycardia, and primary renal disease were distinctly more common in group 2. Massive myocardial infarctions, both old and recent, were found at necropsy. It is concluded that: (1) permanent pacemaker implantation, when combined with drag therapy, is effective in the control of the bradycardia-tachycardia syndrome; (2) the prognosis of patients successfully treated for the bradycardia-tachycardia syndrome is dependent on the extent of the underlying cardiac and renal disease. The bradycardia-tachycardia syndrome was treated with pacemaker implantation and drugs in 28 patients. All patients survived pacemaker implantation and 26 of 28 patients experienced good control of their arrhythmias. Nineteen patients survived for more than one year (group 1); nine patients survived for less than one year (group 2), including two patients whose arrhythmias were not well controlled by pacemaker plus drugs. There was no significant difference in mean age between the two groups (75 ± 5 years in group 1 and 79 ± 3 years in group 2). Gout, diabetes, hypertension, angina pectoris, and cardiomegaly were equally common in both groups. Prior to implantation, 14 of 19 patients in group 1 were in NYHA class 1–2; 8 of 9 patients in group 2 were in NYHA class 3–4. Generally, the clinical classification of cardiac status was not changed by treatment. Myocardial infarction, ventricular tachycardia, and primary renal disease were distinctly more common in group 2. Massive myocardial infarctions, both old and recent, were found at necropsy. It is concluded that: (1) permanent pacemaker implantation, when combined with drag therapy, is effective in the control of the bradycardia-tachycardia syndrome; (2) the prognosis of patients successfully treated for the bradycardia-tachycardia syndrome is dependent on the extent of the underlying cardiac and renal disease. Overview of the Sick Sinus SyndromeCHESTVol. 66Issue 3PreviewThe descriptive name, sick sinus syndrome, was coined by Ferrer1 in 1968 in an article characterizing the various clinical subgroups of sinus dysfunction. Since Ferrer's report, extensive documentation of the wide variety of clinical situations which make up the broad syndrome of sinus dysfunction has been obtained. It is important, as presented by Aroesty and co-workers in this issue of Chest (see page 257 ), to recognize that there are subgroups of this syndrome characterized by: bradycardia/tachycardia, spontaneous paroxysmal sinus arrest, persistent sinus bradycardia, and hypersensitive carotid sinus. Full-Text PDF