From the Guidelines
Sick sinus syndrome is a disorder that requires implantation of a permanent pacemaker to regulate the heart rate, which is the definitive management for symptomatic patients, as it has been shown to be highly effective in relieving symptoms and improving quality of life 1.
Diagnosis and Treatment
The diagnosis of sick sinus syndrome typically involves ECG monitoring, Holter monitoring, or event recorders to capture the abnormal heart rhythms. Symptoms of sick sinus syndrome include fatigue, dizziness, fainting, shortness of breath, and palpitations. The condition is more common in older adults and can be caused by age-related fibrosis of the conduction system, coronary artery disease, or other cardiac conditions.
Medication Management
Medications that slow heart rate, such as beta-blockers, calcium channel blockers, and certain antiarrhythmics, should be avoided or discontinued in these patients as they can worsen symptoms 1. For patients with accompanying atrial fibrillation, anticoagulation therapy may be necessary to prevent blood clots and stroke.
Pacemaker Therapy
Pacemaker therapy is indicated and has proved highly effective in patients with sinus node dysfunction when bradyarrhythmia has been demonstrated to account for 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 improves quality of life 1.
Quality of Life and Morbidity
Without treatment, sick sinus syndrome can lead to serious complications including syncope, heart failure, and increased risk of sudden cardiac death. However, with proper treatment, including pacemaker therapy and medication management, patients with sick sinus syndrome can experience significant improvement in symptoms and quality of life 1.
From the Research
Definition and Treatment of Sick Sinus Syndrome
- Sick sinus syndrome (SSS) is a condition that affects the natural pacemakers of the heart, causing bradycardia (resting heart rate below 60 beats per minute) 2.
- The only effective treatment for patients suffering from symptomatic bradycardia is the implantation of a permanent pacemaker 2.
Comparison of Dual-Chamber and Single-Chamber Pacemakers
- Dual-chamber pacemakers are associated with a statistically significant reduction in reoperation compared with single-chamber atrial pacing 2.
- The risk of paroxysmal atrial fibrillation is also reduced with dual-chamber pacing compared with single-chamber atrial pacing 2.
- No statistically significant difference was found between the pacing modes for mortality, heart failure, stroke, chronic atrial fibrillation, or quality of life 2.
Trends and Predictors of Pacemaker Implantation
- The annual trends for hospitalization with SSS and pacemaker placement have been decreasing 3.
- Variables associated with lower likelihood for pacemaker implantation include young age, female sex, non-Caucasian race, chronic heart failure, and high cardiology inpatient volume 3.
- Greater likelihood for pacemaker implantation is associated with hyperlipidemia, hypertension, and hospitals that are private, large, or with high cardiac procedural volume 3.
Survival and Follow-up after Pacemaker Implantation
- Patients with SSS have a life expectancy that parallels that of the general population, while those with complete heart block or atrial fibrillation have a life expectancy that is considerably lower 4.
- The survival rate of patients with SSS is higher than those with complete heart block or atrial fibrillation, with a 10-year survival rate of 54.5% for SSS patients 4.