Long-term Prognosis in Paced Patients:the Effect of Dual Chamber Pacing and the Factors Influencing on Thromboembolism Hiroto Miura 1 , Takashi Saito 1 , Naoki Yanagiya 1 , Hiroshi Shimizu 2 , Kazuhiko Maki 3 , Wataru Sasaki 3 , Mamoru Miura 1 1The Second Department of Internal Medicine, Akita University 2The First Department of Internal Medicine, Akita City Hospital 3Department of Cardiology, Akita Kumiai Hospital Keyword: ペースメーカー , 血栓塞栓症 , 心房細動 , pacemaker , thromboembolism , atrial fibrillation pp.705-711
Published Date 1995/7/15
DOI https://doi.org/10.11477/mf.1404901087
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To elucidate the problem of long-term prognosis in paced patients with bradyarrhythmias, especially thromboembolism (TE) and atrial fibrillation (Af), we investigated the clinical records of 145 patients. Patients were divided into 2 groups, 80 patients with non-physiological pacing (VVI: referred to as group VP, included 54 with Sick Sinus Syndrome ; SSS and 26 with Atrioventricular Block; AVB) and 65 patients with physiological pacing (DDD, DDI, DVI and AAI: referred to as group PP, included 57 with SSS and 8 with AVB) from 1976 to 1993. The follow-up period after pacemaker implantation was 69.7±47.1 months.There was no significant difference in age, sex, pacing indications or underlying diseases between group VP and PP. 22.5% of patients in group VP had the compli-cation of TE, while no patients had TE in group PP (p<0.01). The incidence of TE was significantly higher in patients with SSS than in patients with AVB (31.5% vs. 3.8%, p<0.01), especially in patients with Ruben-stein type III (40.0%). The average incidence of TE was 4.4% per year in group VP with SSS. A similar high incidence of Af was also noticed in group VP compared to that in group PP (30.0% vs. 12.3%, p< 0.01) and in patients with SSS compared to those with AVB (42.6% vs. 3.8%, p<0.01). Background analyses revealed that the patients with TE had a higher hemato-crit level (40.5±4.7% vs. 37.6±4.3%, p<0.05), and a drug history of diuretics (47.1% vs. 18.9%, p<0.1). The cardiothoracic ratio, the left ventricular ejection frac-tion and the existence of ventriculo-atrial conduction was not statistically different, while the left atrial dimension determined by echocardiography was significantly greater in patients with TE (41.3±5.6mm)than in those without TE (37.7±5.1mm, p<0.05). We also compared the effect of anticoagulant therapy against TE after pacemaker implantation. Patients with SSS in group VP were divided into 4 subgroups; group A (no drugs), group B (anti-platelet drugs except for ticlopidine: aspirin, dipyridamole and toco-pherol), group C (ticlopidine) and group D (warfarin). The incidence of TE in these groups was 31%, 64%, 13% and 0%, respectively. And the recurrence rate of TE was 100%, 50% and 17% in group B, C and D, respec-tively. In conclusion, these results indicate that physio-logical pacing in patients with SSS is effective to pro-tect paced patients with SSS from TE by inhibiting the occurrence of Af, and that, where there is left atrial enlargement, high hematocrit and administration of diuretics are risk factors for TE. Our data endorse warfarin in preference to the other anti-platelet agents for the primary or secondary prevention of TE.

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