Sick sinus syndrome surgery

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Sick sinus syndrome Microchapters


Patient Information


Historical Perspective




Differentiating Sick sinus syndrome from other Diseases

Epidemiology and Demographics


Natural History, Complications and Prognosis


History and Symptoms

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hardik Patel, M.D.


Surgery and Device-Based Therapy

2012 ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities (DO NOT EDIT)[1][2]

Permanent Pacing in Sinus Node Dysfunction (DO NOT EDIT)[2]

Class I
"1. Permanent pacemaker implantation is indicated for sinus node dysfunction (SND) with documented symptomatic bradycardia, including frequent sinus pauses that produce symptoms. (Level of Evidence: C)[3][4][5]"
2. Permanent pacemaker implantation is indicated for symptomatic chronotropic incompetence. (Level of Evidence: C)[3][4][5][6][7]"
3. Permanent pacemaker implantation is indicated for symptomatic sinus bradycardia that results from required drug therapy for medical conditions. (Level of Evidence: C)"
Class III (No Benefit)
"1. Permanent pacemaker implantation is not indicated for SND in asymptomatic patients. (Level of Evidence: C)"
2. Permanent pacemaker implantation is not indicated for SND in patients for whom the symptoms suggestive of bradycardia have been clearly documented to occur in the absence of bradycardia. (Level of Evidence: C)"
"3. Permanent pacemaker implantation is not indicated for SND with symptomatic bradycardia due to nonessential drug therapy. (Level of Evidence: C)"
Class IIa
"1. Permanent pacemaker implantation is reasonable for SND with heart rate less than 40 bpm when a clear association between significant symptoms consistent with bradycardia and the actual presence of bradycardia has not been documented. (Level of Evidence: C)[3][4][5][8][9][10]"
2. Permanent pacemaker implantation is reasonable for syncope of unexplained origin when clinically significant abnormalities of sinus node function are discovered or provoked in electrophysiological studies. (Level of Evidence: C)[11][12]"
Class IIb
"1. Permanent pacemaker implantation may be considered in minimally symptomatic patients with chronic heart rate less than 40 bpm while awake. (Level of Evidence: C)[3][5][6][8][9][10]"


  1. Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes NA, Ferguson TB, Hammill SC, Karasik PE, Link MS, Marine JE, Schoenfeld MH, Shanker AJ, Silka MJ, Stevenson LW, Stevenson WG, Varosy PD (2013). "2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society". J. Am. Coll. Cardiol. 61 (3): e6–75. doi:10.1016/j.jacc.2012.11.007. PMID 23265327.
  2. 2.0 2.1 Epstein AE, Dimarco JP, Ellenbogen KA, Estes NA, Freedman RA, Gettes LS; et al. (2008). "ACC/AHA/HRS 2008 guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: executive summary". Heart Rhythm. 5 (6): 934–55. doi:10.1016/j.hrthm.2008.04.015. PMID 18534377.
  3. 3.0 3.1 3.2 3.3 Kay R, Estioko M, Wiener I (1982). "Primary sick sinus syndrome as an indication for chronic pacemaker therapy in young adults: incidence, clinical features, and long-term evaluation". Am Heart J. 103 (3): 338–42. PMID 6461235.
  4. 4.0 4.1 4.2 Kusumoto FM, Goldschlager N (1996). "Cardiac pacing". N Engl J Med. 334 (2): 89–97. doi:10.1056/NEJM199601113340206. PMID 8531965.
  5. 5.0 5.1 5.2 5.3 Rasmussen K (1981). "Chronic sinus node disease: natural course and indications for pacing". Eur Heart J. 2 (6): 455–9. PMID 7338247.
  6. 6.0 6.1 Linde-Edelstam C, Nordlander R, Pehrsson SK, Rydén L (1992). "A double-blind study of submaximal exercise tolerance and variation in paced rate in atrial synchronous compared to activity sensor modulated ventricular pacing". Pacing Clin Electrophysiol. 15 (6): 905–15. PMID 1376903.
  7. Gammage M, Schofield S, Rankin I, Bennett M, Coles P, Pentecost B (1991). "Benefit of single setting rate responsive ventricular pacing compared with fixed rate demand pacing in elderly patients". Pacing Clin Electrophysiol. 14 (2 Pt 1): 174–80. PMID 1706502.
  8. 8.0 8.1 Shaw DB, Holman RR, Gowers JI (1980). "Survival in sinoatrial disorder (sick-sinus syndrome)". Br Med J. 280 (6208): 139–41. PMC 1600350. PMID 7357290.
  9. 9.0 9.1 Dreifus LS, Michelson EL, Kaplinsky E (1983). "Bradyarrhythmias: clinical significance and management". J Am Coll Cardiol. 1 (1): 327–38. PMID 6826942.
  10. 10.0 10.1 Rubenstein JJ, Schulman CL, Yurchak PM, DeSanctis RW (1972). "Clinical spectrum of the sick sinus syndrome". Circulation. 46 (1): 5–13. PMID 5039825.
  11. Fisher JD (1981). "Role of electrophysiologic testing in the diagnosis and treatment of patients with known and suspected bradycardias and tachycardias". Prog Cardiovasc Dis. 24 (1): 25–90. PMID 7019962.
  12. Reiffel JA, Kuehnert MJ (1994). "Electrophysiological testing of sinus node function: diagnostic and prognostic application-including updated information from sinus node electrograms". Pacing Clin Electrophysiol. 17 (3 Pt 1): 349–65. PMID 7513860.