Incidence of Atrial Fibrillation and Cerebral Stroke in Patients Treated with Ventricular Pacing and Dual-Chamber Pacing

Abstract

Background and Objectives:The occurrences of chronic atrial fibrillation and cerebral stroke were known as major determinants of the clinical course in pacemaker implanted patients. Several reports suggested the different incidence of chronic atrial fibrillation and stroke between the physiologic pacemaker and ventricular pacemaker. We performed this study to assess the effect of the pacing mode on the incidence of chronic atrial fibrillation and cerebral stroke. Materials and Methods:We retrospectively analyzed the clinical data of 291 (Male 97, Female 194)(Mean Age 58) patients who received permanent pacemakers. Those with previous episodes of cerebral ischemia, stroke or chronic atrial fibrillation at the implantation of pacemaker were excluded from the study subjects. The study population included 170 patients paced for sick sinus syndrome and 121 patients paced for complete atrioventricular block or second-degree AV block. Among 291 patients, 197 patients received ventricular pacing mode and dual-chamber pacing mode were implanted for the remaining 94 patients. The mean follow-up period was 65±47 months. The incidence of chronic atrial fibrillation and cerebral stroke were evaluated. Results:Chronic atrial fibrillation occurred in 12.2% (24/197) of patients received ventricular pacing system and 2.1% (2/94) of dual-chamber paced patients. The incidence of cerebral stroke in ventricular pacing group was 6.1% (12/197) and that in dual-chamber pacing group was 3.2% (3/94). Among 26 patients who had chronic atrial fibrillation after pacemaker implantation, 6 (23.1%) patients experienced the complication of cerebral stroke during follow-up period. On the other hand, the incidence of cerebral stroke in patients without accompanying chronic atrial fibrillation was 3.4% (9/265)(p=0.01). Conclusion:The patients received a single-lead ventricular pacing system showed relatively higher incidence of chronic atrial fibrillation occurrence during the clinical course after the pacemaker implantation. However, the incidence of cerebral stroke between the ventricular pacing and dual-chamber pacing group was not statistically significant. (Korean Circulation J 2000;30(6):751-757)