From the Guidelines
Management of Sick Sinus Syndrome
The management of sick sinus syndrome (SSS) typically involves the implantation of a permanent pacemaker to regulate heart rhythm, 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.
Indications for Pacing
Pacing is indicated in patients with SSS who experience symptomatic intermittent sinus arrest or sino-atrial block, as well as those with prolonged sinus pause following the termination of tachycardia in the brady-tachy syndrome 1.
Treatment Approach
The treatment approach should consider the severity and nature of symptomatic arrhythmias, as well as the disease setting 1. In patients with symptomatic bradycardia, medication such as atropine (0.5-1.0 mg intravenously) or isoproterenol (1-10 mcg/min intravenously) may be administered to increase heart rate, while awaiting pacemaker implantation.
Physiological Pacing
Physiological pacing (atrial or dual-chamber) has been shown to be 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.
Elimination of Offending Agents
In some cases, elimination of offending agents such as cardiac glycosides, beta-adrenergic blockers, calcium channel blockers, and membrane-active antiarrhythmic agents may be necessary to prevent syncope recurrence 1.
Key Considerations
- Cardiac pacemaker therapy is indicated in patients with SSS when bradyarrhythmia has been demonstrated to account for syncope 1.
- Physiological pacing is preferred over VVI pacing due to its superior outcomes 1.
- Elimination of offending agents is an important element in preventing syncope recurrence 1.
From the Research
Management of Sick Sinus Syndrome (SSS)
The management of SSS can be approached through various methods, including medication and pacemaker implantation.
- Medications such as cilostazol and theophylline have been studied for their efficacy in treating SSS.
- Cilostazol has been shown to decrease the rate of permanent pacemaker implantation in patients with SSS by increasing heart rate 2.
- Theophylline has also been found to be effective in treating SSS, with studies demonstrating its ability to decrease the frequency and duration of sinus pauses, as well as improve symptoms 3, 4, 5.
Pacemaker Implantation
Pacemaker implantation is a common treatment for SSS, particularly in patients with symptomatic bradycardia.
- Studies have shown that pacemaker therapy can improve symptoms and reduce the incidence of syncope and heart failure in patients with SSS 3, 6.
- The natural history of SSS following permanent pacemaker implantation has been studied, with findings suggesting that pacemaker therapy can successfully control symptoms in many patients, although the underlying dysrhythmia may persist 6.
Comparison of Treatments
Comparisons between cilostazol and theophylline have been made, with one study finding that both medications are effective in increasing heart rate in patients with SSS, although cilostazol may be as effective as theophylline in this regard 5.
- The choice of treatment for SSS may depend on various factors, including the severity of symptoms, the presence of underlying heart disease, and patient preferences.
- Further research is needed to fully understand the optimal management of SSS, including the relative benefits and risks of different treatments 2, 3, 4, 5, 6.