AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Association of Permanent Pacemaker Implantation with Survival and Cardiovascular Outcomes in Sick Sinus Syndrome: A Propensity-Matched Cohort Study
By de Sousa Barzon Serra V, Abdul Nabi H, Zanco J et al.
Background: Sick sinus syndrome (SSS) is a common indication for permanent pacemaker (PPM) implantation. Although PPMs effectively relieve symptomatic bradyarrhythmias, their association with long-term survival and cardiovascular outcomes after rigorous confounder adjustment remains uncertain. Hypothesis: We hypothesized that PPM implantation in patients with SSS would be associated with improved long-term survival and reduced major adverse cardiovascular events (MACE) compared with no implantation, after propensity score matching for comorbidities and cardiac function. Methods: We conducted a retrospective cohort study of adults with SSS identified from the Mayo Clinic enterprise. Patients were stratified by PPM implantation status. One-to-one propensity score matching incorporated demographics (age, sex, race, ethnicity), cardiovascular comorbidities (coronary artery disease, atrial fibrillation, heart failure, hypertension, diabetes), baseline beta-blocker use, and left ventricular ejection fraction (LVEF). The final matched cohort included 5,704 patients per group. Outcomes included all-cause mortality, MACE, hospitalization, cerebrovascular events, and bleeding. Kaplan-Meier analysis and Cox proportional hazards models were used for time-to-event analyses. Results: After matching, 11,408 patients were included. Mean age was 58.6 years (PPM) versus 59.6 years (non-PPM); LVEF was well balanced (57.9% vs 57.1%). At 60 months, overall survival was significantly higher in the PPM group (73.2% vs 68.7%; HR 0.77, 95% CI 0.71-0.84; p<0.0001), as was freedom from MACE (68.3% vs 65.0%; HR 0.83, 95% CI 0.77-0.89; p<0.0001). PPM implantation was associated with higher rates of hospitalization (45.1% vs 40.5%) and cerebrovascular events (7.3% vs 5.7%), but lower rates of bleeding (3.9% vs 5.9%; all p<0.0001). Conclusions: In a large propensity-matched cohort of SSS patients, PPM implantation was independently associated with improved 5-year survival and reduced MACE. These benefits persisted despite higher hospitalization and cerebrovascular event rates, suggesting PPM may confer clinical benefit beyond symptom relief by enabling tolerated medical therapy and mitigating bradyarrhythmia-related risk. Prospective studies are needed to confirm these findings and define optimal candidates for device therapy.