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__NOTOC__
__NOTOC__
{{Sick sinus syndrome}}
{{Sick sinus syndrome}}
{{CMG}}
{{CMG}}; {{AE}} {{HP}}
==Overview==
==Overview==
==Surgery and Device-based Therapy==
The management of sick sinus syndrome depends on the underlying cause and the presenting [[symptoms]]. After correcting the reversible [[causes]] of sick sinus syndrome, it can be managed by placing an implantable pacemaker. [[Indications and usage|Indications]] of the implantable [[pacemaker]] include, [[patients]] with documented [[bradycardia]] and are [[symptomatic]], [[patients]] with chronotropic incompetence, sinus node dysfunction secondary to [[medications]] necessitated by another [[medical condition]], and [[patients]] with [[heart rate]] < 40 per minute.
===ACC/AHA Guidelines- Recommendations for Permanent Pacing in Sinus node Dysfunction===
{{cquote|
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]===


#Permanent pacemaker implantation is indicated for SND with documented symptomatic bradycardia, including frequent sinus pauses that produce symptoms. (Level of Evidence: C)
==Surgery==
#Permanent pacemaker implantation is indicated for symptomatic chronotropic incompetence. (Level of Evidence:C)
The management of sick sinus syndrome depends on the underlying cause and the presenting [[symptoms]]. After correcting the reversible [[causes]] of sick sinus syndrome, it can be managed by placing an implantable [[pacemaker]].
#Permanent pacemaker implantation is indicated for symptomatic sinus bradycardia that results from required drug therapy for medical conditions.(Level of Evidence: C)}}


{{cquote|
==Indication==
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]]===
[[Indications and usage|Indications]] of the implantable [[pacemaker]] include:<ref name="pmid6461235">{{cite journal| author=Kay R, Estioko M, Wiener I| title=Primary sick sinus syndrome as an indication for chronic pacemaker therapy in young adults: incidence, clinical features, and long-term evaluation. | journal=Am Heart J | year= 1982 | volume= 103 | issue= 3 | pages= 338-42 | pmid=6461235 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6461235  }} </ref><ref name="pmid8531965">{{cite journal| author=Kusumoto FM, Goldschlager N| title=Cardiac pacing. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 2 | pages= 89-97 | pmid=8531965 | doi=10.1056/NEJM199601113340206 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8531965  }} </ref><ref name="pmid7338247">{{cite journal| author=Rasmussen K| title=Chronic sinus node disease: natural course and indications for pacing. | journal=Eur Heart J | year= 1981 | volume= 2 | issue= 6 | pages= 455-9 | pmid=7338247 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7338247  }} </ref><ref name="pmid6461235">{{cite journal| author=Kay R, Estioko M, Wiener I| title=Primary sick sinus syndrome as an indication for chronic pacemaker therapy in young adults: incidence, clinical features, and long-term evaluation. | journal=Am Heart J | year= 1982 | volume= 103 | issue= 3 | pages= 338-42 | pmid=6461235 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6461235  }} </ref><ref name="pmid8531965">{{cite journal| author=Kusumoto FM, Goldschlager N| title=Cardiac pacing. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 2 | pages= 89-97 | pmid=8531965 | doi=10.1056/NEJM199601113340206 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8531965  }} </ref><ref name="pmid7338247">{{cite journal| author=Rasmussen K| title=Chronic sinus node disease: natural course and indications for pacing. | journal=Eur Heart J | year= 1981 | volume= 2 | issue= 6 | pages= 455-9 | pmid=7338247 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7338247  }} </ref><ref name="pmid1376903">{{cite journal| author=Linde-Edelstam C, Nordlander R, Pehrsson SK, Rydén L| title=A double-blind study of submaximal exercise tolerance and variation in paced rate in atrial synchronous compared to activity sensor modulated ventricular pacing. | journal=Pacing Clin Electrophysiol | year= 1992 | volume= 15 | issue= 6 | pages= 905-15 | pmid=1376903 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1376903  }} </ref><ref name="pmid1706502">{{cite journal| author=Gammage M, Schofield S, Rankin I, Bennett M, Coles P, Pentecost B| title=Benefit of single setting rate responsive ventricular pacing compared with fixed rate demand pacing in elderly patients. | journal=Pacing Clin Electrophysiol | year= 1991 | volume= 14 | issue= 2 Pt 1 | pages= 174-80 | pmid=1706502 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1706502  }} </ref>
* [[Patients]] with documented [[bradycardia]] and are [[symptomatic]]
* [[Patients]] with chronotropic incompetence
* Sinus node dysfunction secondary to [[medications]] necessitated by another [[medical condition]]
* [[Patients]] with [[heart rate]] < 40 per minute


#Permanent pacemaker implantation is not indicated for SND in asymptomatic patients. (Level of Evidence: C)
==2012 ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities (DO NOT EDIT)<ref name="pmid23265327">{{cite journal |vauthors=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 |title=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 |journal=J. Am. Coll. Cardiol. |volume=61 |issue=3 |pages=e6–75 |year=2013 |pmid=23265327 |doi=10.1016/j.jacc.2012.11.007 |url=}}</ref><ref name="pmid18534377">{{cite journal| author=Epstein AE, Dimarco JP, Ellenbogen KA, Estes NA, Freedman RA, Gettes LS et al.| title=ACC/AHA/HRS 2008 guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: executive summary. | journal=Heart Rhythm | year= 2008 | volume= 5 | issue= 6 | pages= 934-55 | pmid=18534377 | doi=10.1016/j.hrthm.2008.04.015 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18534377  }} </ref>==
#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)
===Permanent Pacing in Sinus Node Dysfunction (DO NOT EDIT)<ref name="pmid18534377">{{cite journal| author=Epstein AE, Dimarco JP, Ellenbogen KA, Estes NA, Freedman RA, Gettes LS et al.| title=ACC/AHA/HRS 2008 guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: executive summary. | journal=Heart Rhythm | year= 2008 | volume= 5 | issue= 6 | pages= 934-55 | pmid=18534377 | doi=10.1016/j.hrthm.2008.04.015 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18534377  }} </ref>===
#Permanent pacemaker implantation is not indicated for SND with symptomatic bradycardia due to nonessential drug therapy. (Level of Evidence: C)}}
{| class="wikitable"
|-
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' Permanent [[pacemaker]] implantation is indicated for sinus node dysfunction (SND) with documented symptomatic [[bradycardia]], including frequent sinus pauses that produce symptoms. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<ref name="pmid6461235">{{cite journal| author=Kay R, Estioko M, Wiener I| title=Primary sick sinus syndrome as an indication for chronic pacemaker therapy in young adults: incidence, clinical features, and long-term evaluation. | journal=Am Heart J | year= 1982 | volume= 103 | issue= 3 | pages= 338-42 | pmid=6461235 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6461235  }} </ref><ref name="pmid8531965">{{cite journal| author=Kusumoto FM, Goldschlager N| title=Cardiac pacing. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 2 | pages= 89-97 | pmid=8531965 | doi=10.1056/NEJM199601113340206 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8531965  }} </ref><ref name="pmid7338247">{{cite journal| author=Rasmussen K| title=Chronic sinus node disease: natural course and indications for pacing. | journal=Eur Heart J | year= 1981 | volume= 2 | issue= 6 | pages= 455-9 | pmid=7338247 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7338247  }} </ref><nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>”</nowiki>'''2.''' Permanent pacemaker implantation is indicated for symptomatic chronotropic incompetence. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<ref name="pmid6461235">{{cite journal| author=Kay R, Estioko M, Wiener I| title=Primary sick sinus syndrome as an indication for chronic pacemaker therapy in young adults: incidence, clinical features, and long-term evaluation. | journal=Am Heart J | year= 1982 | volume= 103 | issue= 3 | pages= 338-42 | pmid=6461235 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6461235  }} </ref><ref name="pmid8531965">{{cite journal| author=Kusumoto FM, Goldschlager N| title=Cardiac pacing. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 2 | pages= 89-97 | pmid=8531965 | doi=10.1056/NEJM199601113340206 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8531965  }} </ref><ref name="pmid7338247">{{cite journal| author=Rasmussen K| title=Chronic sinus node disease: natural course and indications for pacing. | journal=Eur Heart J | year= 1981 | volume= 2 | issue= 6 | pages= 455-9 | pmid=7338247 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7338247  }} </ref><ref name="pmid1376903">{{cite journal| author=Linde-Edelstam C, Nordlander R, Pehrsson SK, Rydén L| title=A double-blind study of submaximal exercise tolerance and variation in paced rate in atrial synchronous compared to activity sensor modulated ventricular pacing. | journal=Pacing Clin Electrophysiol | year= 1992 | volume= 15 | issue= 6 | pages= 905-15 | pmid=1376903 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1376903  }} </ref><ref name="pmid1706502">{{cite journal| author=Gammage M, Schofield S, Rankin I, Bennett M, Coles P, Pentecost B| title=Benefit of single setting rate responsive ventricular pacing compared with fixed rate demand pacing in elderly patients. | journal=Pacing Clin Electrophysiol | year= 1991 | volume= 14 | issue= 2 Pt 1 | pages= 174-80 | pmid=1706502 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1706502  }} </ref><nowiki>"</nowiki>
|-
| bgcolor="LightGreen" |<nowiki>”</nowiki>'''3.''' Permanent pacemaker implantation is indicated for symptomatic sinus bradycardia that results from required drug therapy for medical conditions. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}


{{cquote|
{|class="wikitable"
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]===
|-
| colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit)
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Permanent pacemaker implantation is not indicated for SND in asymptomatic patients. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightCoral"|<nowiki>”</nowiki>'''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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
| bgcolor="LightCoral"|<nowiki>"</nowiki>'''3.''' Permanent pacemaker implantation is not indicated for SND with symptomatic bradycardia due to nonessential drug therapy. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}


#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)
{|class="wikitable"
#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)}}
|-
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<ref name="pmid6461235">{{cite journal| author=Kay R, Estioko M, Wiener I| title=Primary sick sinus syndrome as an indication for chronic pacemaker therapy in young adults: incidence, clinical features, and long-term evaluation. | journal=Am Heart J | year= 1982 | volume= 103 | issue= 3 | pages= 338-42 | pmid=6461235 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6461235  }} </ref><ref name="pmid8531965">{{cite journal| author=Kusumoto FM, Goldschlager N| title=Cardiac pacing. | journal=N Engl J Med | year= 1996 | volume= 334 | issue= 2 | pages= 89-97 | pmid=8531965 | doi=10.1056/NEJM199601113340206 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8531965  }} </ref><ref name="pmid7338247">{{cite journal| author=Rasmussen K| title=Chronic sinus node disease: natural course and indications for pacing. | journal=Eur Heart J | year= 1981 | volume= 2 | issue= 6 | pages= 455-9 | pmid=7338247 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7338247  }} </ref><ref name="pmid7357290">{{cite journal| author=Shaw DB, Holman RR, Gowers JI| title=Survival in sinoatrial disorder (sick-sinus syndrome). | journal=Br Med J | year= 1980 | volume= 280 | issue= 6208 | pages= 139-41 | pmid=7357290 | doi= | pmc=PMC1600350 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7357290  }} </ref><ref name="pmid6826942">{{cite journal| author=Dreifus LS, Michelson EL, Kaplinsky E| title=Bradyarrhythmias: clinical significance and management. | journal=J Am Coll Cardiol | year= 1983 | volume= 1 | issue= 1 | pages= 327-38 | pmid=6826942 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6826942  }} </ref><ref name="pmid5039825">{{cite journal| author=Rubenstein JJ, Schulman CL, Yurchak PM, DeSanctis RW| title=Clinical spectrum of the sick sinus syndrome. | journal=Circulation | year= 1972 | volume= 46 | issue= 1 | pages= 5-13 | pmid=5039825 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5039825  }} </ref><nowiki>"</nowiki>
|-
| bgcolor="LemonChiffon"|<nowiki>”</nowiki>'''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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<ref name="pmid7019962">{{cite journal| author=Fisher JD| title=Role of electrophysiologic testing in the diagnosis and treatment of patients with known and suspected bradycardias and tachycardias. | journal=Prog Cardiovasc Dis | year= 1981 | volume= 24 | issue= 1 | pages= 25-90 | pmid=7019962 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7019962  }} </ref><ref name="pmid7513860">{{cite journal| author=Reiffel JA, Kuehnert MJ| title=Electrophysiological testing of sinus node function: diagnostic and prognostic application-including updated information from sinus node electrograms. | journal=Pacing Clin Electrophysiol | year= 1994 | volume= 17 | issue= 3 Pt 1 | pages= 349-65 | pmid=7513860 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7513860  }} </ref><nowiki>"</nowiki>
|}


{{cquote|
{|class="wikitable"
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]===
|-
 
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
#Permanent pacemaker implantation may be considered in minimally symptomatic patients with chronic heart rate less than 40 bpm while awake. (Level of Evidence: C)}}
|-
 
| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Permanent pacemaker implantation may be considered in minimally symptomatic patients with chronic heart rate less than 40 bpm while awake. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<ref name="pmid6461235">{{cite journal| author=Kay R, Estioko M, Wiener I| title=Primary sick sinus syndrome as an indication for chronic pacemaker therapy in young adults: incidence, clinical features, and long-term evaluation. | journal=Am Heart J | year= 1982 | volume= 103 | issue= 3 | pages= 338-42 | pmid=6461235 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6461235  }} </ref><ref name="pmid7338247">{{cite journal| author=Rasmussen K| title=Chronic sinus node disease: natural course and indications for pacing. | journal=Eur Heart J | year= 1981 | volume= 2 | issue= 6 | pages= 455-9 | pmid=7338247 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7338247  }} </ref><ref name="pmid1376903">{{cite journal| author=Linde-Edelstam C, Nordlander R, Pehrsson SK, Rydén L| title=A double-blind study of submaximal exercise tolerance and variation in paced rate in atrial synchronous compared to activity sensor modulated ventricular pacing. | journal=Pacing Clin Electrophysiol | year= 1992 | volume= 15 | issue= 6 | pages= 905-15 | pmid=1376903 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1376903  }} </ref><ref name="pmid7357290">{{cite journal| author=Shaw DB, Holman RR, Gowers JI| title=Survival in sinoatrial disorder (sick-sinus syndrome). | journal=Br Med J | year= 1980 | volume= 280 | issue= 6208 | pages= 139-41 | pmid=7357290 | doi= | pmc=PMC1600350 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7357290  }} </ref><ref name="pmid6826942">{{cite journal| author=Dreifus LS, Michelson EL, Kaplinsky E| title=Bradyarrhythmias: clinical significance and management. | journal=J Am Coll Cardiol | year= 1983 | volume= 1 | issue= 1 | pages= 327-38 | pmid=6826942 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6826942  }} </ref><ref name="pmid5039825">{{cite journal| author=Rubenstein JJ, Schulman CL, Yurchak PM, DeSanctis RW| title=Clinical spectrum of the sick sinus syndrome. | journal=Circulation | year= 1972 | volume= 46 | issue= 1 | pages= 5-13 | pmid=5039825 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5039825  }} </ref><nowiki>"</nowiki>
Bradyarrhythmias are well controlled with pacemakers, while tachyarrhythmias respond well to medical therapy. However, because both bradyarrhythmias and tachyarrhythmias may be present, drugs to control tachyarrhythmia may exacerbate bradyarrhythmia. Therefore, a pacemaker is implanted before drug therapy is begun for the tachyarrhythmia.<ref>http://www.ncbi.nlm.nih.gov/pubmed/12725451?dopt=Abstract</ref>
|}


==References==
==References==
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[[Category:Electrophysiology]]
[[Category:Syndromes]]
[[Category:Cardiology]]

Latest revision as of 01:28, 9 April 2020

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

Overview

The management of sick sinus syndrome depends on the underlying cause and the presenting symptoms. After correcting the reversible causes of sick sinus syndrome, it can be managed by placing an implantable pacemaker. Indications of the implantable pacemaker include, patients with documented bradycardia and are symptomatic, patients with chronotropic incompetence, sinus node dysfunction secondary to medications necessitated by another medical condition, and patients with heart rate < 40 per minute.

Surgery

The management of sick sinus syndrome depends on the underlying cause and the presenting symptoms. After correcting the reversible causes of sick sinus syndrome, it can be managed by placing an implantable pacemaker.

Indication

Indications of the implantable pacemaker include:[1][2][3][1][2][3][4][5]

2012 ACC/AHA/HRS Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities (DO NOT EDIT)[6][7]

Permanent Pacing in Sinus Node Dysfunction (DO NOT EDIT)[7]

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)[1][2][3]"
”2. Permanent pacemaker implantation is indicated for symptomatic chronotropic incompetence. (Level of Evidence: C)[1][2][3][4][5]"
”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)[1][2][3][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)[1][3][4][8][9][10]"

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 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.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Kusumoto FM, Goldschlager N (1996). "Cardiac pacing". N Engl J Med. 334 (2): 89–97. doi:10.1056/NEJM199601113340206. PMID 8531965.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Rasmussen K (1981). "Chronic sinus node disease: natural course and indications for pacing". Eur Heart J. 2 (6): 455–9. PMID 7338247.
  4. ↑ 4.0 4.1 4.2 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.
  5. ↑ 5.0 5.1 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.
  6. ↑ 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.
  7. ↑ 7.0 7.1 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.
  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.

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