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{{SK}} Bradycardia-tachycardia syndrome, tachycardia-bradycardia syndrome, tachy-brady syndrome, sinus node dysfunction, SND, SSS. [[Sinus arrest]], [[sinus bradycardia]], are forms or variants of sick sinus syndrome.
{{SK}} Bradycardia-tachycardia syndrome, tachycardia-bradycardia syndrome, tachy-brady syndrome, sinus node dysfunction, SND, SSS. [[Sinus arrest]], [[sinus bradycardia]], are forms or variants of sick sinus syndrome.
==Diagnosis==
Ambulatory monitoring of the [[electrocardiogram]] (ECG) may be necessary because arrhythmias are transient.  The ECG may show any of the following
* Inappropriate [[sinus bradycardia]]
* [[Sinus arrest]]
* [[Sinoatrial block]]
* [[Atrial fibrillation]] with slow ventricular response
* A prolonged [[asystolic]] period after a period of tachycardias
* [[Atrial flutter]]
* [[Ectopic atrial tachycardia]]
* [[Sinus node reentrant tachycardia]]
Electrophysiologic tests are no longer used for diagnostic purposes because of their low specificity and sensitivity. Cardioinhibitory and vasodepressor forms of sick sinus syndrome may be revealed by [[tilt table test]]ing.
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Image:SSS ecg 001.jpg|Sick Sinus Syndrome
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==Treatment==
==Treatment==

Revision as of 03:56, 28 August 2012

Sick sinus syndrome
Sick sinus syndrome
ICD-10 I49.5
ICD-9 427.81
OMIM 163800
DiseasesDB 12066

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

Synonyms and keywords: Bradycardia-tachycardia syndrome, tachycardia-bradycardia syndrome, tachy-brady syndrome, sinus node dysfunction, SND, SSS. Sinus arrest, sinus bradycardia, are forms or variants of sick sinus syndrome.

Treatment

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.

ACC / AHA Guidelines- Recommendations for Permanent Pacing in Sinus Node Dysfunction (DO NOT EDIT) [1]

Class I

1. Permanent pacemaker implantation is indicated for SND with documented symptomatic bradycardia, including frequent sinus pauses that produce symptoms. (Level of Evidence: C)

2. Permanent pacemaker implantation is indicated for symptomatic chronotropic incompetence. (Level of Evidence: C)

3. Permanent pacemaker implantation is indicated for symptomatic sinus bradycardia that results from required drug therapy for medical conditions. (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)

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)

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)

Class III

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)

External links

References

  • Adan V, Crown LA (2003). "Diagnosis and treatment of sick sinus syndrome". Am Fam Physician. 67 (8): 1725–32. PMID 12725451.
  1. Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM III, 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. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). Circulation. 2008; 117: 2820–2840. PMID 18483207

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