# Impact of Coronavirus Disease 2019 on Sick Sinus Syndrome: Trends in Incidence and Pacemaker Implantation

## TL;DR

This study finds that the incidence of sick sinus syndrome increased after the start of the COVID-19 pandemic, with a notable rise in pacemaker implantations in older adults.

## Contribution

The study provides the first evidence of a post-COVID-19 increase in sick sinus syndrome and pacemaker implantation rates using a large-scale health database.

## Key findings

- SSS incidence increased significantly after March 2020 in the overall population.
- PPM implantation rates rose significantly in older adults post-COVID-19.
- Younger patients had increased SSS incidence but no change in pacemaker implantation rates.

## Abstract

Sick sinus syndrome (SSS) is a cardiac conduction disorder that often necessitates pacemaker implantation, especially in older adults. Emerging evidence suggests a potential association between coronavirus disease 2019 (COVID-19) infection and SSS, but the impact on SSS trends and permanent pacemaker (PPM) implantation rates remains unclear. This study compares the pre- and post–COVID-19 trends in SSS incidence and PPM implantation rates. Using the TriNetX Research Network, we analyzed the monthly incidence rate (IR) of SSS and the rate of PPM implantation in the overall population from January 2018 to December 2023. Additionally, we conducted a subgroup analysis focusing on patients >50 years of age to examine trends in IR and PPM implantations during the same period. To evaluate changes before and after COVID-19, we used interrupted time series analysis, with March 1, 2020, as the cutoff. In the overall SSS population, the IR increased significantly post–COVID-19 (IR, 1.80 cases/100,000 person-years [PY] per month; P < .001), which was accompanied by a significant rise in PPM implantation rates (119.16 cases/100,000 PY per month; P < .001). Among patients <50 years of age, the IR increased post–COVID-19 (IR, 0.355 cases/100,000 PY per month; P < .001), but PPM implantation rates in this subgroup remained unchanged (P = .897). Our findings suggest an increase in SSS incidence across all age groups post–COVID-19. However, the lack of increased PPM implantation in younger patients may reflect either a more transient disease course or a higher threshold for device implantation in this age group. Further research is needed to determine the prognosis of SSS in the recent era.