From the Guidelines
The treatment for Sick Sinus Syndrome (SSS) 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.
Key Considerations
- Pacemaker implantation is often the most effective treatment, as it can provide a consistent and reliable heartbeat, and physiological pacing (atrial or dual-chamber) has been shown to be superior to VVI pacing 1.
- The type of pacemaker used may vary, but a dual-chamber pacemaker is often recommended to maintain a normal heart rhythm, and newly developed atrial-based minimal ventricular pacing modes are recommended as an alternative to conventional DDDR pacing 1.
- Medication may be prescribed to control symptoms, such as beta blockers or anti-arrhythmic medications, but elimination of offending agents that may exacerbate or unmask underlying susceptibility to bradycardia is an important element in preventing syncope recurrence 1.
- Patients with SSS may also require treatment for underlying conditions, such as high blood pressure or coronary artery disease, to help manage their overall cardiovascular health.
Important Notes
- Pacemaker implantation may not affect survival, but it can frequently relieve symptoms 1.
- Despite adequate pacing, syncope recurs in about 20% of patients in long-term follow-up, due to the frequent association of a vasodepressor reflex mechanism with sinus node disease 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 Options for Sick Sinus Syndrome (SSS)
The treatment for Sick Sinus Syndrome (SSS) includes:
- Removing extrinsic factors, when possible 3
- Pacemaker placement, which can decrease symptoms and improve quality of life, but does not reduce mortality 3
- Implantation of permanent pacemakers, which has become the treatment of choice for patients suffering from SSS 4
- Use of dual chamber pacemakers with novel fallback algorithms, which can be effective in treating SSS associated with transient supraventricular tachyarrhythmia 5
Pacemaker Implantation
Pacemaker implantation has been shown to have an excellent symptomatic effect in patients with SSS, with significant improvement in symptoms such as syncopes and severe dizziness 4
- A study of 109 patients with SSS treated with permanent pacemakers found that 104 patients had symptomatic improvement after implantation 4
- Another study found that adequate pacing of the heart was effective in controlling attacks of tachyarrhythmia in patients with bradycardia-tachycardia syndrome 6
Mode Selection and Programming
The selection of pacemaker mode and programming is important in treating SSS, with evidence suggesting that appropriate mode selection can ameliorate symptoms and decrease the incidence of complications 7
- A review of advances in pacing for SSS noted that revolutionary advances in pacemaker hardware and programmability allow for careful tailoring of device, mode, and program for the individual patient and underlying electrophysiologic abnormalities 7