Work

Long-term outcomes of single atrial lead pacing in sick sinus syndrome: Risk stratification using Wenckebach block rate

Year: 2026

Type: article

Abstract: Background In patients with sick sinus syndrome, concern regarding long-term atrioventricular conduction stability often favors dual-chamber implantation. Although single atrial lead pacing may be feasible in selected patients, the long-term natural history of atrioventricular conduction remains insufficiently characterized. Objective To evaluate near-lifetime ventricular lead requirements after single atrial lead pacing and determine whether baseline Wenckebach block rate stratifies long-term risk of ventricular lead addition for bradyarrhythmia. Methods We retrospectively analyzed 142 patients with symptomatic sick sinus syndrome who underwent electrophysiological study and received single atrial lead pacing between 1991 and 2010. Patients had preserved atrioventricular conduction and baseline Wenckebach block rate ≥100 bpm and were stratified by a pre-specified 130-bpm threshold. Results During a median follow-up of 206 months, 97 patients were followed until death. Ventricular lead addition for bradyarrhythmia occurred in 10 patients, corresponding to 0.45 per 100 person-years. Incidence rates were 1.18 and 0.18 per 100 person-years in patients with baseline Wenckebach block rate <130 bpm and ≥130 bpm, respectively (log-rank p=0.002). Baseline Wenckebach block rate predicted lead addition with an AUC of 0.78, and a 120-bpm threshold provided a negative predictive value of 97.3%. Conclusions Over extended follow-up, ventricular lead addition was rarely required after single atrial lead pacing in carefully selected patients with sick sinus syndrome and preserved atrioventricular conduction. Lower baseline Wenckebach block rate was associated with a higher long-term risk of ventricular lead addition.

Source: Heart Rhythm O2

DOI: 10.1016/j.hroo.2026.08.147