Stroke in paced patients with sick sinus syndrome: Influence of left atrial function and size

Patients with sick sinus syndrome have a high prevalence of cerebral ischemia. The present study was designed to establish the prevalence of stroke in patients with sick sinus syndrome and the role of atrial size and function. This prospective study analyzed 100 consecutive patients with sick sinus syndrome without atrial fibrillation who received either dual chamber or ventricular pacemakers. Patients underwent a cranial CT scan at the time of enrollment and again at the end of the study 24 months later. Endpoint of the study was cerebral ischemia. Clinical and echocardiographic features were assessed at the beginning of the study. A multivariate regression analysis was applied to all variables that had at least a marginal univariate predictive value. Cerebral ischemia occurred in 18 patients. Univariate predictors for embolism were age > 65 years (p < 0.001), low atrial ejection force (p < 0.01) and a dilated left atrium with spontaneous echo contrast (p < 0.05). These findings identified patients at high risk for the development of peripheral embolism among the group of patients paced for sick sinus syndrome.