Serial electrophysiologic studies after single chamber atrial pacemaker implantation in patients with symptomatic sinus node dysfunction

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Abstract
After single chamber atrial pacemaker implantation, serial electrophysiologic studies were performed noninvasively at intervals of 3 months over a total period of 3 years in 24 patients with symptomatic sinus node dysfunction. All patients underwent invasive electrophysiologic studies before pacemaker implantation and demonstrated intact anterograde AV conduction. Patients were divided into 2 groups group I did not require antiarrhythmic drugs during follow-up whereas group 2 received antiarrhythmic drugs. In group 1(11 patients) the atrial paced heart rate producing AV Wenckebach phenomenon (AVWHR) remained stable during a mean follow-up of 22±10 months, with a variability not exceeding 10 beats min−1 with respect to the initial AVWHR obtained during preoperative electrophysiologic study. In group 2 (13 patients) with a mean follow-up of 15±8 months a mean decrease of AVWHR of 19.2±17.5 beats min−1 was present between AVWHR before and 3 months after initiation of oral antiarrhythmic drugs (P3 months) antiarrhythmic drug therapy the variability of the AVWHR never exceeded 10 beats min−1 with respect to the AVWHR obtained 3 months after the initiation of oral drug therapy. Deterioration of anterograde AV conduction during long-term follow-up of patients with symptomatic sinus node dysfunction and intact anterograde AV conduction at the time of pacemaker implantation is a consequence of orally taken antiarrhythmic drugs, rather than a consequence of degeneration of the AV conducting system.

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