1. SSS is the most common indication for a permanent pacemaker. This disease of the SA and AV nodes accounts for 48 percent of primary pacemaker implants. Retrospective analysis indicates that a reduction in mortality and in the incidence of CHF, AF, and thromboembolism occurs in patients with atrial pacing (AAI or DDD) compared to ventricular pacing (VVI).

2. Treatment of atrial tachyarrhythmias with digoxin, quinidine, disopyramide, procainamide, propranolol, or verapamil carries the risk of aggravating preexisting AV block or sinus arrest. Therefore, most patients should have pacemaker implantation before drug therapy is begun.

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