From the Guidelines
Sick sinus syndrome is a disorder that requires prompt treatment, primarily involving the implantation of a permanent pacemaker to regulate heart rhythm, as recommended by the most recent guidelines 1. The condition is characterized by symptoms such as fatigue, dizziness, fainting, shortness of breath, chest pain, palpitations, confusion, and in some cases, no symptoms at all.
Diagnosis and Treatment
The diagnosis of sick sinus syndrome is made through electrocardiogram (ECG), Holter monitoring, event recording, and electrophysiology studies. Treatment options include:
- Implanting a permanent pacemaker to regulate heart rhythm, which is a minimally invasive procedure requiring a short hospital stay
- Medications, such as anticoagulants like warfarin or direct oral anticoagulants (DOACs) to prevent blood clots and reduce stroke risk, especially if atrial fibrillation is present
- Beta-blockers or calcium channel blockers to control rapid heart rates
- Discontinuation of medications that can worsen the condition, such as certain antiarrhythmics, calcium channel blockers, and beta-blockers
Importance of Pacemaker Therapy
Pacemaker therapy is indicated in patients with sinus node dysfunction when bradyarrhythmia has been demonstrated to account for syncope, as it has been shown to be highly effective in relieving symptoms 1. Physiological pacing, such as atrial or dual-chamber pacing, is superior to VVI pacing, as it lowers the risk of developing atrial fibrillation and improves quality of life by reducing symptoms of congestive heart failure, low cardiac output, and angina pectoris 1.
Regular Follow-up Appointments
Regular follow-up appointments are essential to monitor pacemaker function and adjust medications as needed. This ensures that the patient receives optimal treatment and reduces the risk of complications. By prioritizing the implantation of a permanent pacemaker and adjusting medications as needed, patients with sick sinus syndrome can experience significant improvements in their quality of life and reduction in symptoms.
From the Research
Symptoms of Sick Sinus Syndrome
- Syncope or near-fainting occurs in about one-half of patients 2
- Cerebral hypoperfusion is most common, with symptoms related to end-organ hypoperfusion 2
- Patients may experience pre-syncope, palpitations, or dizziness 3
- Subtle or nonspecific symptoms are common, making diagnosis challenging 3
- Alternating patterns of bradycardia and tachycardia (bradycardia-tachycardia syndrome) may occur 3
Treatment of Sick Sinus Syndrome
- Pacemaker placement is the mainstay of treatment, providing effective relief of symptoms 3
- Atrial or dual-chamber pacemaker placement can lower the incidence of atrial fibrillation, thromboembolic events, heart failure, and mortality 3
- Removing extrinsic factors, when possible, is also a part of treatment 2
- Theophylline may be used to relieve symptoms, but its impact on the natural course of the disease is unknown 4
- Dual-chamber rate-responsive pacemaker therapy can reduce the incidence of heart failure and syncope 4
Pacemaker Therapy
- Dual-chamber pacemaker therapy is associated with a lower incidence of heart failure and syncope 4
- Atrial pacing is associated with a lower incidence of congestive heart failure and consumption of diuretics than ventricular pacing 5
- Ventricular pacing is associated with a decrease in left ventricular fractional shortening and an increased dilatation of the left atrium 5
- Rate-responsive dual chamber pacing may reduce the incidence of syncope compared to rate-responsive single chamber pacing 6