Risk of sick sinus syndrome in patients diagnosed with atrial fibrillation: A population-based cohort

Pil Sung Yang, Daehoon Kim, Eunsun Jang, Hee Tae Yu, Tae Hoon Kim, Jung Hoon Sung, Hui Nam Pak, Moon Hyoung Lee, Boyoung Joung

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


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 2014 in 302 229 SSS- and pacemaker-free subjects 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 subjects (0.69%/year). The incidence of SSS was 3.4 and 0.2 per 1000 person-years in the propensity score-matched incident AF and no-AF groups, respectively. After adjustment, the significantly increased risk of SSS was observed in the incident AF group, 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 10 times increased risk of SSS in an elderly population regardless of comorbidities. The risk of pacemaker implantations related with both sinus node dysfunction and AV block was increased in the elderly population with incident AF.

Original languageEnglish
Pages (from-to)2704-2714
Number of pages11
JournalJournal of Cardiovascular Electrophysiology
Issue number10
Publication statusPublished - 2021 Oct

Bibliographical note

Funding Information:
Access to the National Health Information Database was provided by the NHIS of Korea. The authors would like to thank the NHIS for their cooperation. This study was supported by a research grant from the Korean Healthcare Technology R&D project funded by the Ministry of Health and Welfare (HI15C1200, HC19C0130).

Publisher Copyright:
© 2021 Wiley Periodicals LLC

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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