Systemic embolism in chronic sinoatrial disorder.

We attempted to estimate the prevalence of systemic embolism in patients with chronic sino-atrial disorder. In a group of 100 patients, evidence of embolism was found in 16, of whom 15 had the bradycardia-tachycardia syndrome. In 712 controls with chronic complete heart block, who were matched for age and sex, embolism had occurred in only 1.3 per cent (P less than 0.001). A second group of 41 patients with chronic ventricular bradycardia and atrial flutter or fibrillation had an embolic prevalence of 7.3 per cent, which was also greater than that in the controls (P less than 0.05). All patients with sinoatrial disorder in whom systemic embolism developed were over 54 years of age; multiple episodes occurred in six. The risk of embolization remains even if the bradycardia-tachycardia syndrome is replaced by stable atrial fibrillation. Impaired atrial function appears to be a key factor in predisposing to intracardiac thrombosis, and paroxysmal supraventricular tachycardia increases the risk of subsequent embolization.

[1]  T. N. James,et al.  Pathology of the Cardiac Conduction System in a Case of Diphtheria Associated with Atrial Arrhythmias and Heart Block , 1963, Circulation.

[2]  E. Braunwald.  An editorial introduction to the symposium , 1966 .

[3]  H. Fleming,et al.  Mitral valve disease, systemic embolism and anticoagulants* , 1971, Postgraduate medical journal.

[4]  O. Narula.  Atrioventricular Conduction Defects in Patients with Sinus Bradycardia: Analysis by His Bundle Recordings , 1971, Circulation.

[5]  D. Julian,et al.  Sick Sinus Syndrome: Experience of a Cardiac Pacemaker Clinic , 1974, British medical journal.

[6]  O. Orning,et al.  The efficacy of anticoagulant therapy in preventing embolism related to D.C. electrical conversion of atrial fibrillation. , 1969, The American journal of cardiology.

[7]  D. Short.  THE SYNDROME OF ALTERNATING BRADYCARDIA AND TACHYCARDIA , 1954, British heart journal.

[8]  H. Siddons.  Deaths in long-term paced patients. , 1974, British heart journal.

[9]  L. Kurland,et al.  Natural History of Stroke in Rochester, Minnesota, 1955 Through 1969: An Extension of a Previous Study, 1945 Through 1954 , 1973, Stroke.

[10]  A. Fairfax,et al.  Neurological aspects of sinoatrial heart block. , 1976, Journal of neurology, neurosurgery, and psychiatry.

[11]  J. Ord,et al.  The hemodynamic effects of paroxysmal supraventricular tachycardia in patients with the Wolff-Parkinson-White syndrome. , 1962, The American journal of cardiology.

[12]  R. Desanctis,et al.  Clinical Spectrum of the Sick Sinus Syndrome , 1972, Circulation.

[13]  H. H. Samarasinghe,et al.  Permanent neurological deficits complicating sinoatrial block. , 1973, British heart journal.

[14]  R. Shekelle,et al.  Hypertension and Risk of Stroke in an Elderly Population , 1974, Stroke.

[15]  E. Flensted-Jensen.  Wolff-Parkinson-White syndrome. A long-term follow-up of 47 cases. , 2009 .

[16]  M. Davies,et al.  Quantitative study of ageing changes in the human sinoatrial node and internodal tracts. , 1972, British heart journal.

[17]  J. V. Durme.  Tachyarrhythmias and transient cerebral ischemic attacks. , 1975 .

[18]  D. Shaw,et al.  Sick sinus syndrome. , 1973, British medical journal.

[19]  V. Krishnaswami,et al.  Permanent pacing in disorders of sinus node function. , 1975, American heart journal.