From the Guidelines
The recommended treatment for a patient with sick sinus syndrome is implantation of a permanent pacemaker, specifically a dual-chamber pacemaker, which has been shown to be effective in relieving symptoms and improving quality of life 1.
Treatment Approach
The treatment approach should be individualized based on the patient's specific symptoms, age, comorbidities, and the predominant arrhythmia pattern.
- Before pacemaker implantation, temporary measures may include administration of atropine or isoproterenol for acute symptomatic bradycardia.
- For patients with tachycardia-bradycardia syndrome, a dual-chamber pacemaker is often preferred to allow for appropriate rate control medications.
- Common medications that may be prescribed after pacemaker placement include beta-blockers (such as metoprolol 25-100 mg twice daily) or calcium channel blockers (such as diltiazem 120-360 mg daily in divided doses) to control tachyarrhythmias.
- Anticoagulation with warfarin (target INR 2-3) or direct oral anticoagulants may be necessary if atrial fibrillation is present, based on stroke risk assessment.
Rationale
Pacemaker therapy is effective because it provides a reliable electrical stimulus to initiate cardiac depolarization when the sinus node fails to generate adequate impulses, thereby preventing symptomatic bradycardia and associated complications such as syncope, heart failure, or sudden cardiac death 1.
Key Considerations
- Elimination of drugs that may exacerbate or unmask underlying susceptibility to bradycardia is an important element in preventing syncope recurrence 1.
- Percutaneous cardiac ablative techniques for atrial tachyarrhythmia control may be considered in selected patients with the bradycardia –tachycardia form of sick sinus syndrome 1.
From the Research
Treatment Options for Sick Sinus Syndrome
The treatment for sick sinus syndrome (SSS) typically involves the use of permanent pacemakers or medications to manage symptoms.
- Permanent pacemakers have been shown to have an excellent symptomatic effect in patients with SSS, with a significant reduction in symptoms such as syncope and dizziness 2.
- The use of oral theophylline has also been studied as a potential treatment for SSS, with some studies suggesting that it may be beneficial in reducing the frequency and duration of sinus pauses 3.
- Another medication, cilostazol, has been investigated as a potential treatment for SSS, with a retrospective case-control study suggesting that it may be effective in avoiding permanent pacemaker implantation by increasing heart rate 4.
Pacemaker Therapy
Pacemaker therapy is a common treatment for SSS, with dual-chamber rate-responsive pacemakers being used to relieve symptoms.
- A randomized controlled trial found that pacemaker therapy was associated with a lower incidence of syncope and heart failure compared to no treatment or theophylline therapy 5.
- The use of low interatrial septal pacing has also been studied, with a case report suggesting that it may be effective in reducing P-wave duration and PR interval in patients with SSS 6.
Medication Therapy
Medication therapy, including theophylline and cilostazol, may be used to manage symptoms of SSS.