loading page

Risk of sick sinus syndrome in patients diagnosed with atrial fibrillation: a population-based cohort
  • +6
  • Pil-Sung Yang,
  • Daehoon Kim,
  • Eunsun Jang,
  • Hee Tae Yu,
  • Tae-Hoon Kim,
  • Jung-Hoon Sung,
  • Hui-Nam Pak,
  • Moon-Hyoung Lee,
  • Boyoung Joung
Pil-Sung Yang
CHA Bundang Medical Center

Corresponding Author:[email protected]

Author Profile
Daehoon Kim
Yonsei University Health System
Author Profile
Eunsun Jang
Yonsei University Health System
Author Profile
Hee Tae Yu
Yonsei University College of Medicine
Author Profile
Tae-Hoon Kim
Yonsei University Health System
Author Profile
Jung-Hoon Sung
Bundang CHA Medical Center, CHA University, Seongnam
Author Profile
Hui-Nam Pak
Yonsei University Health System
Author Profile
Moon-Hyoung Lee
Yonsei Cardiovascular Center and Cardiovascular Research
Author Profile
Boyoung Joung
Yonsei Cardiovascular Center and Cardiovascular Research
Author Profile


Background: Sinoatrial node dysfunction and atrial fibrillation (AF) frequently coexist and interact with each other, often to initiate and perpetuate each other. Objective: To determine the effect of AF on the incidence and risk of sick sinus syndrome (SSS). Methods: The association of incident AF with the development of incident SSS was assessed from 2004 to 2013 in 302,229 SSS- and pacemaker-free participants aged ≥60 years in the Korea National Health Insurance Service-Senior cohort. Results: During an observation period of 1,854,800 person-years, incident AF was observed in a total of 12,797 participants (0.69%/year). The incidence of SSS was 0.2 and 3.4 per 1000 person-years in the incident AF and the propensity score matched no-AF groups, respectively. After adjustment, the risk of SSS caused by incident AF was significantly increased, with a hazard ratio (HR) of 13.4 (95% confidence interval [CI]: 8.4–21.4). This finding was consistently observed after censoring for heart failure (HR, 16.0; 95% CI: 9.2–28.0) or heart failure/myocardial infarction (HR, 16.6; 95% CI: 9.3-29.7). Incident AF also was associated with an increased risk of pacemaker implantation related with both SSS (HR, 21.8; 95% CI: 8.7–18.4) and atrioventricular (AV) block (HR, 9.5; 95% CI: 4.9–18.4). These results were consistent regardless of sex and comorbidities. Conclusion: Incident AF was associated with more than ten times increased risk of SSS in an elderly population regardless of comorbidities. Risk of pacemaker implantations related with both sinus node dysfunction and AV block were increased in elderly population with incident AF.
06 Mar 2021Submitted to Journal of Cardiovascular Electrophysiology
10 Mar 2021Submission Checks Completed
10 Mar 2021Assigned to Editor
12 Mar 2021Reviewer(s) Assigned
05 Apr 2021Review(s) Completed, Editorial Evaluation Pending
08 Apr 2021Editorial Decision: Revise Minor
25 Jun 20211st Revision Received
30 Jun 2021Submission Checks Completed
30 Jun 2021Assigned to Editor
30 Jun 2021Reviewer(s) Assigned
29 Jul 2021Review(s) Completed, Editorial Evaluation Pending
30 Jul 2021Editorial Decision: Accept
Oct 2021Published in Journal of Cardiovascular Electrophysiology volume 32 issue 10 on pages 2704-2714. 10.1111/jce.15202