A randomized comparison of amiodarone and class IC antiarrhythmic drugs to treat atrial fibrillation in patients paced for sinus node disease: The Prevention Investigation and Treatment: A Group for Observation and Research on Atrial arrhythmias (PITAGORA) trial

2008 ◽  
Vol 155 (1) ◽  
pp. 100.e1-100.e9 ◽  
Author(s):  
Michele Gulizia ◽  
Salvatore Mangiameli ◽  
Serafino Orazi ◽  
Giacomo Chiarandà ◽  
Guglielmo Piccione ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Antiarrhythmic Drugs ◽  
Sinus Node ◽  
Atrial Arrhythmias ◽  
Node Disease ◽  
Sinus Node Disease

Atrial tachyarrhythmias in bradycardia–tachycardia syndrome: characterization and evolution

ESC CardioMed ◽  
2018 ◽  
pp. 1954-1957
Author(s):  
Luigi Padeletti ◽  
Roberto De Ponti
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Flutter ◽  
Sinus Node ◽  
Ventricular Myocardium ◽  
Sinus Node Dysfunction ◽  
Ventricular Pacing ◽  
Atrial Tachyarrhythmia ◽  
Atrial Tachyarrhythmias ◽  
Node Disease ◽  
Sinus Node Disease

The association of sinus node disease and atrial tachyarrhythmias characterizes the bradycardia–tachycardia syndrome, which may result in an increased risk of heart failure, stroke, and death. Ageing and several cardiac and extracardiac diseases, which have the potential to affect both the atrial and the ventricular myocardium, can manifest their influence predominantly on the atria, leading to an atrial cardiomyopathy. In these cases, the same pathological process which leads to sinus node dysfunction can create a favourable substrate also for atrial tachyarrhythmias, which, if not present at the time of the initial diagnosis of the sinus node disease, can occur with an increasing prevalence during follow-up. In younger patients with no evident structural heart disease, a bradycardia–tachycardia syndrome may be the first clinical and unexpected manifestation of a still undiagnosed inherited genetic disease and therefore a specific diagnostic workup is necessary. In bradycardia–tachycardia syndrome, the most frequently encountered atrial tachyarrhythmia is atrial fibrillation, while typical atrial flutter is rarer. In peculiar subgroups of patients, other atrial tachyarrhythmias, such as atypical atrial flutter, macroreentrant or focal atrial tachycardia, may be present. In bradycardia–tachycardia syndrome, the evolution of atrial tachyarrhythmias clearly shows a worsening with an prevalence of associated atrial tachyarrhythmia over time. Pharmacological therapy for arrhythmias is of limited use, due to the concomitant sinus node dysfunction. The modality of pacing used to manage the sinus node disease has to be carefully chosen to minimize the evolution of atrial tachyarrhythmias. In fact, while ventricular pacing increases the incidence of atrial fibrillation and stroke, dual-chamber pacing with a specific algorithm for ventricular pacing minimization and prevention and treatment of atrial tachyarrhythmias reduces a composite endpoint of evolution to permanent atrial fibrillation, hospitalization, and death.

P5675Ischemic stroke in patient with sinus node disease in comparison to atrial fibrillation, bradycardia-tachycardia syndrome and other cardiac conditions: a nationwide cohort-study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Bodin ◽  
A Bisson ◽  
N Clementy ◽  
B Pierre ◽  
J Herbert ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Sinus Node ◽  
Control Population ◽  
National Database ◽  
Control Group ◽  
Cardiac Condition ◽  
Node Disease ◽  
Sinus Node Disease

Abstract Atrial fibrillation (AF) may be associated with sinus node disease (SND) presenting as a brady-tachy syndrome (BTS), known to be at risk for embolic ischemic stroke (IS). It remains unclear whether the risk of IS is increased in patients with isolated SND. Methods This French longitudinal cohort study was based on the national database covering hospital care from for the entire population (PMSI) from 2010 to 2015. We compared incidences of IS in patients with a diagnosis of AF or SND to that in a control group of patients with a main diagnosis of cardiac condition (excluding those with AF or SND, history of stroke and mechanical valve or mitral stenosis). Results Of 1,732,412 patients included in the cohort, 1,601,435 (92.44%) had isolated AF, 102,849 (5.94%) had isolated SND and 28,128 (1.62%) had BTS. The control group with cardiac condition included 479,108 patients. Incidence of IS progressively increased when considering patients from the control population, patients with isolated SND, with BTS or with isolated AF (0.67%/yr, 1.95%/yr, 3.03%/yr and 5.48%/yr respectively). These differences were seen in all strata of CHA2DS2VASc score (table). SND patients with a CHA2DS2-VASc score ≥3 had a yearly incidence of IS >2%, comparable to AF population with a CHA2DS2-VASc score ≥1. Incidence (%/year) of ischemic stroke CHA2DS2-VASc AF population SND population “Control” population Women Men Women Men Women Men All scores 6.72% 4.37% 1.93% 1.96% 0.67% 0.68% Score = 0 – 1.960% – 1.211% – 0.217% Score = 1 2.337% 3.046% 0.538% 1.486% 0.166% 0.345% Score = 2 3.917% 4.499% 0.879% 1.541% 0.298% 0.580% Score = 3 7.572% 4.733% 2.207% 2.084% 0.541% 0.907% Score = 4 7.016% 4.820% 2.363% 2.305% 0.930% 1.278% Score = 5 6.725% 5.345% 2.845% 2.849% 1.249% 1.553% Score = 6 7.637% 7.543% 3.319% 4.109% 1.737% 2.031% Score = 7 10.196% 13.927% 4.663% 7.708% 2.346% 4.089% Score = 8 17.654% 12.607% 8.519% 11.904% 2.446% 2.355% Conclusion Patients with isolated SND had a lower risk of IS than patients with AF or BTS. However, SND patients had a non-neglectable risk of IS during follow-up which was higher than in a “control” population. Whether oral anticoagulation may bring a significant clinical benefit might be studied in patients with SND at highest risk of IS.

Pacing in sinus node disease to prevent atrial fibrillation

2012 ◽  
Vol 10 (7) ◽  
pp. 851-858 ◽  
Author(s):  
Mads Brix Kronborg ◽  
Jens Cosedis Nielsen
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Node ◽  
Node Disease ◽  
Sinus Node Disease

scholarly journals Ischemic Stroke in Patients With Sinus Node Disease, Atrial Fibrillation, and Other Cardiac Conditions

Stroke ◽  
2020 ◽  
Vol 51 (6) ◽  
pp. 1674-1681
Author(s):  
Alexandre Bodin ◽  
Arnaud Bisson ◽  
Christophe Gaborit ◽  
Julien Herbert ◽  
Nicolas Clementy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Sinus Node ◽  
Hazard Ratio ◽  
Control Population ◽  
National Database ◽  
Cardiac Diseases ◽  
Node Disease ◽  
Sinus Node Disease ◽  
Yearly Rate

Background and Purpose— Atrial fibrillation (AF) is known to increase risk of ischemic stroke (IS), but the risk of IS in isolated sinus node disease (SND) is unclear. We compared the incidence of IS in patients with SND, patients with AF, and in a control population with other cardiac diseases (disease of the circulatory system using the International Classification of Diseases, Tenth Revision ). Methods— This French longitudinal cohort study was based on the national database covering hospital care for the entire population from 2008 to 2015. Results— Of 1 692 157 patients included in the cohort, 100 366 had isolated SND, 1 564 270 had isolated AF, and 27 521 had AF associated with SND. Incidence of IS during follow-up was higher in isolated patients with AF than in AF associated with SND (yearly rate 2.22% versus 2.06%) and in isolated patients with AF than in isolated patients with SND (yearly rate 2.22% versus 1.59%). The incidence of IS was lower in a control population with other cardiac conditions (n=479 108) compared with SND and patients with AF (0.96%/y, 1.59%/y, and 2.22%/y, respectively). After 1:1 propensity score matching, SND was associated with lower incidence of IS compared to AF (hazard ratio, 0.77 [95% CI, 0.73–0.82]) but higher incidence of IS compared to control population (hazard ratio, 1.27 [95%CI, 1.19–1.35]). Conclusions— Patients with SND had a lower risk of thromboembolic events than patients with AF but a higher risk than a control population with other cardiac diseases. Randomized clinical trial in a selected SND population, with, for example, a high CHA 2 DS 2 -VASc score, would be required to determine the value of IS prevention by anticoagulation.

scholarly journals P835Prognosis in patients with atrial fibrillation and sinus node disease in a community based cohort study

EP Europace ◽  
2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii153-iii153
Author(s):  
L. Fauchier ◽  
A. Bodin ◽  
A. Bisson ◽  
C. Andre ◽  
N. Clementy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Sinus Node ◽  
Community Based ◽  
Node Disease ◽  
Sinus Node Disease
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