Abstract
Sick Sinus Syndrome (SSS) has been identified as a risk factor for ischemic stroke. Thrombus assessment in SSS patients without atrial fibrillation (AF) or atrial flutter (AFL) remains underexplored. We aims to develop a predictive model for ischemic stroke risk specifically in SSS patients without AF/AFL. Patients diagnosed with SSS and without AF/AFL were consecutively enrolled from single center. Incident AF/AFL cases were excluded during follow-up period. Symptomatic ischemic stroke was confirmed by reviewing the all available medical records. After a median follow-up of 1215 days, 187 out of 1645 (11.9%) patients experienced symptomatic ischemic stroke. Key predictors identified via multivariable Cox regression included age, left atrial diameter (LAD), prolonged P-wave duration (PWD), neutrophil-lymphocyte ratio (NLR), non-AF atrial tachyarrhythmias, and prior thrombotic events. These variables were incorporated into our nomogram prediction model, which demonstrated superior calibration and performance compared to the CHA2DS2-VASc score. The incidence of new-onset ischemic stroke in SSS patients is notably high, warranting focused attention in clinical practice. We developed the model evaluate the risk for ischemic stroke of SSS patients without AF/AFL and internally validated. This risk score performs better than CHA2DS2-VASC score and may providing evidence of thrombus assessment in patients with atrial myopathy.
Data availability
The data presented in this study are available upon request from the corresponding author.
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Acknowledgements
We are grateful to all the physicians involved in patients management and device programming.
Funding
This work was supported by National Key Research and Development Program of China (Grant number 2022YFC2405002).
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Conceptualization: Yiheng Yang and Yunlong Xia; Data curation: Haoyu Dong and Yiheng Yang; Methodology and formal Analysis: Yiheng Yang and Haoyu Dong; Statistical Analysis, Haoyu Dong and Yiheng Yang; Investigation: Haoyu Dong, Shihao Wang and Rongfeng Zhang; Resource: Yingxue Dong, Xiaomeng Yin; Software: Yushan Wei; Writing—Original Draft Preparation: Haoyu Dong; Writing—Review and Editing: Yiheng Yang and Xiaolei Yang ; Validation: Lianjun Gao. Supervision: Yunlong Xia and Xiaolei Yang . Funding acquisition: Yunlong Xia; Visualization: Xiaolei Yang and Yiheng Yang. Project administration: Xiaolei Yang and Yiheng Yang. All authors have reviewed and agreed to the published version of the manuscript.
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All patient information in the database is anonymized and therefore does not require informed consent according to the regulations of Ethics committee of First affiliated hospital of Dalian Medical University. Study protocol adheres to the principles of Declaration of Helsinki, and has been approved by the Ethics committee of First affiliated hospital of Dalian Medical University (PJ-KS-KY-2022-306).
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Yang, Y., Dong, H., Wang, S. et al. Ischemic stroke prediction model of sick sinus syndrome patients without atrial fibrillation: insights from atrial myopathy. Sci Rep (2026). https://doi.org/10.1038/s41598-026-39742-7
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DOI: https://doi.org/10.1038/s41598-026-39742-7
