Sick sinus syndrome medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]
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. Asymptomatic patients are usually monitored without therapy.
Medical 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.[1]
- Clinical indications of the implantable pacemaker include:
- Asymptomatic patients are followed without any treatment.
- Pharmacologic agents for the treatment of sick siuns syndrome include:
- Caffeine
- β-sympathomimetics (e.g., theophylline)
- Oral vagolytic agents such as glycopyrrolate or atropine
- Asymptomatic patients are usually monitored without therapy.
2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay [2]
Acute Management of Reversible Causes of Sinus Node Dysfunction
| Class I |
| "1. In symptomatic patients presenting with sinus node dysfunction (SND), evaluation and treatment of reversible causes is recommended. (Level of Evidence: C)" |
Acute Medical Therapy for Bradycardia
| Class IIa |
| "1.In patients with SND associated with symptoms or hemodynamic compromise, atropine is reasonable to increase sinus rate (Level of Evidence: C)" [3] |
| "2.In patients with SND associated with symptoms or hemodynamic compromise who are at low likelihood of coronary ischemia, isoproterenol, dopamine, dobutamine, or epinephrine may be considered to increase heart rate and improve symptoms.(Level of Evidence: C)" [4][5][6][7] |
References
- ↑ Dakkak W, Doukky R. PMID 29261930. Missing or empty
|title=(help) - ↑ 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: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society". Circulation. 140 (8). doi:10.1161/CIR.0000000000000627. ISSN 0009-7322.
- ↑ Brady, William J.; Swart, Gary; DeBehnke, Daniel J.; Ma, O.John; Aufderheide, Tom P. (1999). "The efficacy of atropine in the treatment of hemodynamically unstable bradycardia and atrioventricular block: prehospital and emergency department considerations". Resuscitation. 41 (1): 47–55. doi:10.1016/S0300-9572(99)00032-5. ISSN 0300-9572.
- ↑ Redmond JM, Zehr KJ, Gillinov MA, Baughman KL, Augustine SM, Cameron DE, Stuart RS, Acker MA, Gardner TJ, Reitz BA (1993). "Use of theophylline for treatment of prolonged sinus node dysfunction in human orthotopic heart transplantation". J. Heart Lung Transplant. 12 (1 Pt 1): 133–8, discussion 138–9. PMID 8443190.
- ↑ Heinz, Gottfried; Kratochwill, Christoph; Buxbaum, Peter; Laufer, Günther; Kreiner, Gerhard; Siostrzonek, Peter; Gasic, Slobodan; Derfler, Kurt; Gössinger, Heinz (1993). "Immediate normalization of profound sinus node dysfunction by aminophylline after cardiac transplantation". The American Journal of Cardiology. 71 (4): 346–349. doi:10.1016/0002-9149(93)90805-M. ISSN 0002-9149.
- ↑ Warren, James V.; Lewis, Richard P. (1976). "Beneficial effects of atropine in the pre-hospital phase of coronary care". The American Journal of Cardiology. 37 (1): 68–72. doi:10.1016/0002-9149(76)90501-4. ISSN 0002-9149.
- ↑ Swart, Gary; Brady, William J; DeBehnke, Daniel J; John, O; Aufderheide, Tom P (1999). "Acute myocardial infarction complicated by hemodynamically unstable bradyarrhythmia: Prehospital and ED treatment with atropine". The American Journal of Emergency Medicine. 17 (7): 647–652. doi:10.1016/S0735-6757(99)90151-1. ISSN 0735-6757.