Sick sinus syndrome electrocardiogram

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Sick sinus syndrome is a collection of heart rhythm disorders that include sinus bradycardia, sinus pauses and sinus arrest. Sick sinus syndrome can evolve towards causing atrial fibrillation, atrial flutter, ectopic atrial tachycardia, sinus node reentrant tachycardia, and tachycardia-bradycardia.


Ambulatory monitoring of the electrocardiogram (EKG) may be necessary because arrhythmias are transient. The EKG may show any of the following:[1][2]

Electrophysiologic tests are no longer used for diagnostic purposes because of their low specificity and sensitivity. Cardio-inhibitory and vasodepressor forms of sick sinus syndrome may be revealed by tilt table testing.

Shown below is an EKG demonstrating sick sinus syndrome. Atrial fibrillation is present (an irregularly irregular rhythm) which stops abruptly due to sinus arrest.

Copyleft image obtained courtesy of ECGpedia,

Shown below is an EKG showing the termination of a supraventricular tachycardia at about 130/min. which terminates and leaves a pause and then sinus bradycardia. This is a from of "tachy/brady" syndrome where a tachycardia is followed by a bradycardia.

Copyleft image obtained courtesy of ECGpedia,

For more EKG examples of sick sinus syndrome click here.


2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay [3]

Term Definition
Sinus Node Dysfunction
  • Sinoatrial exit block: Evidence that blocked conduction between the sinus node and adjacent atrial tissue is present. Multiple electrocardiographic manifestations including “group beating” of atrial depolarization and sinus pauses.  
  • Tachycardia-bradycardia (“tachy-brady”) syndrome: Sinus bradycardia, ectopic atrial bradycardia, or sinus pause alternating with periods of abnormal atrial tachycardia, atrial flutter, or AF. The tachycardia may be associated with suppression of sinus node automaticity and a sinus pause of variable duration when the tachycardia terminates.  
  • Chronotropic incompetence: Broadly defined as the inability of the heart to increase its rate commensurate with increased activity or demand, in many studies translates to failure to attain 80% of expected heart rate reserve during exercise.  


  1. Rubenstein, Joel J.; Schulman, Charles L.; Yurchak, Peter M.; Desanctis, Roman W. (1972). "Clinical Spectrum of the Sick Sinus Syndrome". Circulation. 46 (1): 5–13. doi:10.1161/01.CIR.46.1.5. ISSN 0009-7322.
  2. Park, Hyung Wook; Cho, Jeong Gwan; Yum, Ju Hyup; Hong, Young Joon; Lim, Ji Hyun; Kim, Han Gyun; Kim, Ju Han; Kim, Weon; Ahn, Young Keun; Jeong, Myung Ho; Park, Jong Chun; Kang, Jung Chaee (2004). "Clinical Characteristics of Hypervagotonic Sinus Node Dysfunction". The Korean Journal of Internal Medicine. 19 (3): 155–159. doi:10.3904/kjim.2004.19.3.155. ISSN 1226-3303.
  3. Kusumoto, Fred M.; Schoenfeld, Mark H.; Barrett, Coletta; Edgerton, James R.; Ellenbogen, Kenneth A.; Gold, Michael R.; Goldschlager, Nora F.; Hamilton, Robert M.; Joglar, José A.; Kim, Robert J.; Lee, Richard; Marine, Joseph E.; McLeod, Christopher J.; Oken, Keith R.; Patton, Kristen K.; Pellegrini, Cara N.; Selzman, Kimberly A.; Thompson, Annemarie; Varosy, Paul D. (2019). "2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay". Journal of the American College of Cardiology. 74 (7): e51–e156. doi:10.1016/j.jacc.2018.10.044. ISSN 0735-1097.

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