TY - JOUR
T1 - Association between sick sinus syndrome and atrial fibrillation
T2 - A systematic review and meta-analysis
AU - Liu, Ying
AU - Zheng, Yi
AU - Tse, Gary
AU - Bazoukis, George
AU - Letsas, Konstantinos
AU - Goudis, Christos
AU - Korantzopoulos, Panagiotis
AU - Li, Guangping
AU - Liu, Tong
N1 - Publisher Copyright:
© 2023 Elsevier B.V.
PY - 2023/6/15
Y1 - 2023/6/15
N2 - Aims: Sick sinus syndrome (SSS) and atrial fibrillation (AF) frequently coexist and show a bidirectional relationship. This systematic review and meta-analysis aimed to decipher the precise relationship between SSS and AF, further exploring and comparing different therapy strategies on the occurrence or progression of AF in patients with SSS. Methods and results: A systematic literature search was conducted until November 2022. A total of 35 articles with 37,550 patients were included. Patients with SSS were associated with new-onset AF compared to those without SSS. Catheter ablation was associated with a lower risk of AF recurrence, AF progression, all-cause mortality, stroke and hospitalization of heart failure compared to pacemaker therapy. Regarding the different pacing strategies for SSS, VVI/VVIR has higher risk of new-onset AF than DDD/DDDR. No significant difference was found between AAI/AAIR and DDD/DDDR, as well as between DDD/DDDR and minimal ventricular pacing (MVP) for AF recurrence. AAI/AAIR was associated with higher risk of all-cause mortality when compared to DDD/DDDR, but lower risk of cardiac death when compared to DDD/DDDR. Right atrial septum pacing was associated with a similar risk of new-onset AF or AF recurrence compared to right atrial appendage pacing. Conclusion: SSS is associated with a higher risk of AF. For patients with both SSS and AF, catheter ablation should be considered. This meta-analysis re-emphasizes that high percentage of ventricular pacing should be avoided in patients with SSS in order to decrease AF burden and mortality.
AB - Aims: Sick sinus syndrome (SSS) and atrial fibrillation (AF) frequently coexist and show a bidirectional relationship. This systematic review and meta-analysis aimed to decipher the precise relationship between SSS and AF, further exploring and comparing different therapy strategies on the occurrence or progression of AF in patients with SSS. Methods and results: A systematic literature search was conducted until November 2022. A total of 35 articles with 37,550 patients were included. Patients with SSS were associated with new-onset AF compared to those without SSS. Catheter ablation was associated with a lower risk of AF recurrence, AF progression, all-cause mortality, stroke and hospitalization of heart failure compared to pacemaker therapy. Regarding the different pacing strategies for SSS, VVI/VVIR has higher risk of new-onset AF than DDD/DDDR. No significant difference was found between AAI/AAIR and DDD/DDDR, as well as between DDD/DDDR and minimal ventricular pacing (MVP) for AF recurrence. AAI/AAIR was associated with higher risk of all-cause mortality when compared to DDD/DDDR, but lower risk of cardiac death when compared to DDD/DDDR. Right atrial septum pacing was associated with a similar risk of new-onset AF or AF recurrence compared to right atrial appendage pacing. Conclusion: SSS is associated with a higher risk of AF. For patients with both SSS and AF, catheter ablation should be considered. This meta-analysis re-emphasizes that high percentage of ventricular pacing should be avoided in patients with SSS in order to decrease AF burden and mortality.
KW - Atrial fibrillation
KW - Catheter ablation
KW - Pacemaker
KW - Sick sinus syndrome
UR - http://www.scopus.com/inward/record.url?scp=85152461367&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2023.03.066
DO - 10.1016/j.ijcard.2023.03.066
M3 - Article
C2 - 37023861
AN - SCOPUS:85152461367
SN - 0167-5273
VL - 381
SP - 20
EP - 36
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -