EMmedonline

• Sick sinus syndrome is a generalized abnormality of cardiac impulse formation that may be caused by intrinsic disease of the sinus node or by extrinsic cause.

• They manifest as sinus bradycardia, sinus arrest or exit block, combinations of sino-atrial and atrioventricular nodal conduction disturbances , atrial tachyarrhythmias & alternating bradyarrythmias & tachyarrhytmias.

• They may present with palpitation, dizzy spells or syncope due to intermittent tachycardia, bradycardia or pauses with no atrial or ventricular activity.

Tachycardia Bradycardia Syndrome : Note the tachyarrythmia is followed by a period of sinus pause or sinus arrest before initiation of electrical impulse from SA node.

Etiology

Diagnosis

• ECG

• Holter Monitoring

• Electrophysiological Studies

Treatment

• Pacemaker is warranted in patients with sick sinus syndrome.

  Indications for Pacemaker in Sick Sinus Syndrome   Class I   SSS with documented symptomatic bradycardia, including frequent sinus pauses that produces symptoms. Symptomatic chronotropic incompetence   Class IIa   SSS occurring spontaneously or as a result of necessary drug therapy, with heart rate less than 40 bpm when a clear association between significant symptoms consistent with bradycardia and the actual presence of bradycardia has not been documented. Class IIb In minimally symptomatic patients with chronic heart rate less than 30 bpm while awake

Updated on 25/6/2015

Reference

• Diagnosis & Treatment of Sick Sinus Syndrome. Victor Adan. American Family Physician. 2003.

• Goldberger's Clinical Electrocardiography. A simplified Approach. 8^Th Edition

• Marriot's Practical Electrocardiography. 12^Th Edition.

• Davidson 21^st Edition