Incidence of and risk factors for sick sinus syndrome in the general population

Paul N. Jensen, Noelle N. Gronroos, Lin Y. Chen, Aaron R. Folsom, Chris Defilippi, Susan R. Heckbert, Alvaro Alonso

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169 Scopus citations


Background Little is known about the incidence of and risk factors for sick sinus syndrome (SSS), a common indication for pacemaker implantation. Objectives This study sought to describe the epidemiology of SSS. Methods This analysis included 20,572 participants (mean baseline age 59 years, 43% male) in the ARIC (Atherosclerosis Risk In Communities) study and the CHS (Cardiovascular Health Study), who at baseline were free of prevalent atrial fibrillation and pacemaker therapy, had a heart rate of ≥50 beats/min unless using beta blockers, and were identified as of white or black race. Incident SSS cases were identified by hospital discharge International Classification of Disease-revision 9-Clinical Modification code 427.81 and validated by medical record review. Results During an average 17 years of follow-up, 291 incident SSS cases were identified (unadjusted rate 0.8 per 1,000 person-years). Incidence increased with age (hazard ratio [HR]: 1.73; 95% confidence interval [CI]: 1.47 to 2.05 per 5-year increment), and blacks had a 41% lower risk of SSS than whites (HR: 0.59; 95% CI: 0.37 to 0.98). Incident SSS was associated with greater baseline body mass index, height, N-terminal pro-B-type natriuretic peptide, and cystatin C, with longer QRS interval, with lower heart rate, and with prevalent hypertension, right bundle branch block, and cardiovascular disease. We project that the annual number of new SSS cases in the United States will increase from 78,000 in 2012 to 172,000 in 2060. Conclusions Blacks have a lower risk of SSS than whites, and several cardiovascular risk factors were associated with incident SSS. With the aging of the population, the number of Americans with SSS will increase dramatically over the next 50 years.

Original languageEnglish (US)
Pages (from-to)531-538
Number of pages8
JournalJournal of the American College of Cardiology
Issue number6
StatePublished - Aug 12 2014

Bibliographical note

Funding Information:
The ARIC study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute (NHLBI) contracts HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C. This CHS study research was supported by contracts HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, and NHLBI grant HL080295 , with additional contribution from the National Institute of Neurological Disorders and Stroke . Additional support was provided by the National Institute on Aging grant AG023629 . A full list of principal CHS investigators and institutions can be found at . This study was additionally funded by NHLBI grants R21 HL109611 , T32 HL07770 , and T32 HL007902 . Ms. Gronroos is an employee of Blue Cross Blue Shield of Minnesota (hired after data analysis of this study was complete). Dr. deFilippi has received research funding from Roche Diagnostics . All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.


  • epidemiology
  • pacemaker
  • sick sinus syndrome
  • tachy-brady syndrome


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