What is the treatment for sick sinus syndrome?

From the Guidelines

Pacemaker implantation is the most effective treatment for sick sinus syndrome, particularly when bradyarrhythmia has been demonstrated to account for syncope, as it can significantly improve symptoms and quality of life. The treatment of sick sinus syndrome typically involves addressing the underlying cause and managing symptoms.

Key Considerations

• The choice of pacemaker mode is crucial, with atrial-based pacing (such as AAI or DDD) being superior to VVI pacing in reducing the risk of developing atrial fibrillation and improving quality of life 1.
• Elimination of drugs that may exacerbate or unmask underlying susceptibility to bradycardia is an important element in preventing syncope recurrence, and cardiac pacing may be necessary when substitution is not feasible 1.
• Lifestyle modifications, such as reducing caffeine and alcohol intake, quitting smoking, and managing stress, are also important in managing sick sinus syndrome.

Treatment Approach

• Atrial-based pacing, such as AAIR or DDDR pacing, is recommended as the first-line treatment for sick sinus syndrome, as it has been shown to reduce the risk of stroke and atrial fibrillation compared to VVI pacing 1.
• Medications, such as anticoagulants, may be prescribed to prevent blood clots and reduce stroke risk, especially if atrial fibrillation is present.
• Regular follow-up appointments with a cardiologist are essential to monitor the condition and adjust treatment as needed.

Important Considerations

• The treatment approach should be individualized based on the patient's specific needs and medical history.
• The patient's quality of life and symptoms should be carefully monitored and addressed through a comprehensive treatment plan.

From the Research

Treatment Options for Sick Sinus Syndrome

• Pacemakers: Dual-chamber rate-responsive pacemaker therapy has been shown to be effective in reducing the incidence of syncope and heart failure in patients with symptomatic sick sinus syndrome 2.
• Theophylline: Oral theophylline has been found to improve symptom scores and reduce the incidence of heart failure in patients with symptomatic sick sinus syndrome 2, 3.
• Cilostazol: Cilostazol has been shown to be effective in increasing heart rate and reducing symptoms in patients with sick sinus syndrome, and may be used as an alternative to theophylline or pacemaker therapy 3, 4.

Patient Selection for Treatment

• Symptomatic patients: Patients with symptomatic sick sinus syndrome are more likely to benefit from treatment with pacemakers, theophylline, or cilostazol 2, 5, 4.
• Young adults: Primary sick sinus syndrome is a common indication for permanent pacemaker therapy in young adults, and patients can expect symptomatic improvement with pacing 5.
• Patients who decline pacemaker implantation: Cilostazol may be an effective alternative for patients who decline pacemaker implantation, as it can increase heart rate and reduce symptoms 4.

Trends in Pacemaker Implantation

• Decreasing trends: The annual trends for hospitalization with sick sinus syndrome and pacemaker placement have been decreasing over the past 11 years 6.
• Predictors of pacemaker implantation: Variables associated with higher likelihood of pacemaker implantation include hyperlipidemia, hypertension, and hospital characteristics such as private, large, Northeastern location, or high cardiac procedural volume 6.