Hospitalization for permanent pacemaker implantation in the context of isolated sinus node dysfunction is associated with increased mortality compared with an outpatient strategy

Alexander Sharp, Gareth Matthews, Nikolaos Papageorgiou, Richard Till, Daniel Raine, Ian Williams, Cairistine Grahame-Clarke, Santosh Nair, Omar Abdul-Samad, Vassilios Vassiliou, Pankaj Garg, Wei Yao Lim

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Background: Permanent pacemaker (PPM) implantation is a well-established treatment for symptomatic sinus node dysfunction (SND). The optimal timing of this intervention is unclear, with atrioventricular blocks often prioritized in resource stressed waiting lists due to mortality concerns. Methods: Mortality data was compared between patients receiving elective outpatient (OP) PPM implantation, and those presenting to hospital for urgent inpatient (IP) management for symptomatic SND. Survival analysis was conducted using Kaplan-Meier plots and compared using the log-rank test. Univariable and multivariable Cox regression, as well as propensity score matching analyses were performed to assess the prognostic effect on 30-day and 1-year all-cause mortality of inpatient implant. Results: Of the 1269 patients identified with isolated SND, 740 (58%) had PPMs implanted on an OP and 529 (42%) on an IP basis. Mortality was significantly worse in patients where management was driven by hospital admission on an urgent basis (Log-Rank χ2 = 21.6, p < 0.001) and remained an independent predictor of 1-year all-cause mortality (HR 3.40, 95% CI 1.97–5.86, p < 0.001) on multivariable analysis. Conclusions: SND is predominantly a disease associated with ageing and comorbid populations, where avoidance of deconditioning, hospitalization acquired infections, and polypharmacy is advantageous. Admission avoidance is therefore the preferable strategy.

Original languageEnglish
Pages (from-to)1465-1471
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Issue number12
Early online date1 Nov 2023
Publication statusPublished - Dec 2023


  • admission avoidance
  • aging
  • frailty
  • permanent pacemaker
  • sick sinus syndrome
  • sinus node disease/dysfunction

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