Patients with sick sinus syndrome who also have heart failure with preserved ejection fraction experience a higher burden of atrial fibrillation and more frequent cardiovascular events following pacemaker implantation, according to new findings presented at ESC 2025.

In a retrospective study of 131 patients with preserved ejection fraction, 52 met diagnostic criteria for heart failure with preserved ejection fraction. Over three years, these patients experienced cardiovascular events at a rate of 28.8 percent, compared to 11.4 percent in patients without heart failure. Episodes of atrial fibrillation were significantly more common, including events lasting one hour or more, one day or more, and seven days or more.

A simplified version of the HFA–PEFF score, based on E/e’ ratio, tricuspid regurgitation gradient, left atrial volume index, and brain natriuretic peptide, was able to identify patients at greatest risk. These findings suggest that systematic assessment of heart failure with preserved ejection fraction in patients receiving pacemakers could help guide closer monitoring and early intervention to reduce adverse outcomes.