What is the treatment for Sick Sinus Syndrome (SSS)?

From the Guidelines

Treatment for Sick Sinus Syndrome (SSS)

The treatment for sick sinus syndrome typically involves the use of a pacemaker to regulate the heartbeat, as it has been shown to be highly effective in patients with sinus node dysfunction when bradyarrhythmia has been demonstrated to account for syncope 1.

• Pacemaker implantation is often the most effective treatment, as it can provide a consistent and reliable heartbeat, with dual-chamber pacemaker being recommended to maintain a normal heart rhythm 1.
• In some cases, medication may be prescribed to control symptoms, such as beta blockers like metoprolol to slow the heart rate, or anti-arrhythmic medications like flecainide to prevent abnormal heart rhythms.
• Elimination of offending agents that may exacerbate or unmask underlying susceptibility to bradycardia is an important element in preventing syncope recurrence, with cardiac pacing being necessary when substitution is not feasible 1.
• Percutaneous cardiac ablative techniques for atrial tachyarrhythmia control may be used in selected patients with the bradycardia –tachycardia form of sick sinus syndrome 1.
• Patients with sick sinus syndrome may also require treatment for underlying conditions, such as high blood pressure or coronary artery disease, to help manage their overall cardiovascular health.
• The use of rate-adaptive pacing (especially atrial-based rate-responsive pacing) may be warranted for purposes of both minimizing exertion-related lightheadedness or syncope 1.
• Physiological pacing (atrial or dual-chamber) has been definitely shown to be superior to VVI pacing, as it lowers the risk of developing atrial fibrillation and may improve quality of life by reducing symptoms of congestive heart failure, low cardiac output and angina pectoris 1.

From the FDA Drug Label

Flecainide acetate should be used only with extreme caution in patients with sick sinus syndrome because it may cause sinus bradycardia, sinus pause, or sinus arrest. The treatment for Sick Sinus Syndrome (SSS) is not explicitly stated in the drug label, but it does provide information on the use of flecainide acetate in patients with SSS, indicating that it should be used with extreme caution due to the potential for worsening of the condition.

• The label recommends careful monitoring and consideration of alternative treatments.
• Pacemaker therapy may be necessary in some cases. 2

From the Research

Treatment for Sick Sinus Syndrome (SSS)

The treatment for Sick Sinus Syndrome (SSS) primarily involves the implantation of a permanent pacemaker.

• The use of permanent pacemakers has been shown to have an excellent symptomatic effect in patients with SSS, with significant improvement in symptoms such as syncopes and dizziness 3.
• Advances in pacemaker hardware and programmability have allowed for tailored device, mode, and program selection for individual patients, which can help ameliorate symptoms and decrease the incidence of complications 4.
• The treatment of SSS with permanent cardiac pacemaker has been found to be effective in controlling attacks of tachyarrhythmia in patients with bradycardia-tachycardia syndrome 5.
• Dual-chamber pacemakers (DDD/R) can maintain atrioventricular synchrony, but their effectiveness compared to single-chamber ventricular back-up pacing is still being studied 6.
• Pacemaker diagnostics can be used to determine treatment and outcome in SSS with paroxysmal atrial fibrillation, leading to changes in medical management and pacemaker programming 7.

Types of Pacemakers Used

• Permanent pacemakers are the most commonly used treatment for SSS, with various modes and programs available to suit individual patient needs 3, 4.
• Dual-chamber pacemakers (DDD/R) are sometimes referred to as physiological pacemakers, as they maintain atrioventricular synchrony 6.
• Single-chamber ventricular back-up pacing is also used in some cases, although its effectiveness compared to dual-chamber pacemakers is still being studied 6.

Effectiveness of Treatment

• The implantation of permanent pacemakers has been shown to have a significant symptomatic effect in patients with SSS, with improvement in symptoms such as syncopes and dizziness 3.
• The use of pacemaker diagnostics can help determine treatment and outcome in SSS with paroxysmal atrial fibrillation, leading to changes in medical management and pacemaker programming 7.
• The prognosis for patients with SSS is mainly determined by the presence or absence of coronary heart disease and/or heart failure 3.