Sick sinus syndrome

Background

• Collection of bradyarrhythmias with or without tachycardia
• 50% have alternating bradycardia and tachycardia

Clinical Features

• Clinical manifestations related to end-organ hypoperfusion
  • Syncope/pre-syncope (50%)

Differential Diagnosis

Causes

• Intrinsic:
  • degenerative fibrosis
  • infiltrative disease process
  • ion channel dysfunction
  • SA node remodeling
• Extrinsic:
  • pharmacologic
  • metabolic/electrolyte disturbance
  • autonomic, OSA

Diagnosis

• ECG identification, inpatient telemetry, outpatient Holter monitoring, event monitoring, loop monitoring
  • ECG frequently negative for findings early in disease course

Management

• remove extrinsic factors and/or pacemakers
  • Pacemakers do not reduce mortality, only decrease symptoms

Disposition

• Admit

Complications

• (50%) Tachy-brady syndrome with atrial fibrillation or atrial flutter
• (50%) AV block

See Also

• Symptomatic Bradycardia