The role of pacemaker in the prevention of atrial fibrillation in patients with sick sinus syndrome

Objective: This retrospective study examined the relationship between atrial pacing parameters and atrial fibrillation (AF) occurrence in patients with sick sinus syndrome (SSS) who received dual-chamber pacemakers. Methods: Sixty SSS patients who underwent dual pacemaker implantation were studied. Demographics, clinical data, and device information were collected, and patients were followed for up to 2 years post-implantation. Statistical analyses assessed the association between atrial pacing parameters and AF development. Receiver operating characteristic (ROC) analysis identified potential predictors of AF, focusing on atrial pacing frequency and mode switch episodes. Results: Higher atrial pacing frequency significantly reduced AF risk at all time points (p<0.001), while lower pacing rates did not correlate with AF incidence. The number of atrial premature beats and mode switch episodes showed significant correlations with AF occurrence in the early post-implantation period but lost significance over time. Multivariable Cox regression analysis indicated that the number of atrial premature beats had no significant effect on AF development. However, an inverse relationship was observed between atrial pacing frequency and AF occurrence in the first and third months post-implantation. Conclusion: Maintaining a higher atrial pacing frequency emerges as a valuable strategy to reduce AF risk in dual-chamber pacemaker recipients with SSS. Notably, atrial premature beats and mode-switching episodes primarily influenced AF risk during the early post-implantation phase. This underscores the importance of monitoring and optimizing atrial pacing parameters, especially in the initial stages following pacemaker implantation, for effective AF management in SSS patients.