Sick Sinus syndrome

Presented by nisa
10.10.11
 What Is Sick Sinus Syndrome?

 Sick sinus syndrome (SSS) is abnormalities in sinus node

impulse formation and propagation.
 When the sinus node malfunctions several different
abnormalities may result:
 Sinus bradycardia
 Sinus pause or sinus arrest
 bradycardia-tachycardia syndrome
 sinoatrial exit block
 chronotropic incompetence
Sinus Bradycardia

 Persistent slow rate from the SA node. The parameters

from this waveform include:
 Rate = 55 bpm
 PR interval = 180 ms (0.18 seconds)

Stuart Allen 06
Sinus Arrest

2.8-second arrest

 Failure of sinus node discharge resulting in the absence of atrial

depolarisation and periods of ventricular asystole
 Rate = 75 bpm
 PR interval = 180 ms (0.18 seconds)
 2.8 second arrest
Stuart Allen 06
Brady-Tachy Syndrome

 Intermittent episodes of slow and fast rates from the SA

node or atria
 Rate during bradycardia = 43 bpm
 Rate during tachycardia = 130 bpm

Stuart Allen 06
SA Exit Block

2.1-second pause

 Transient blockage of impulses from the SA node

 Rate = 52 bpm
 PR interval = 180 ms (0.18 seconds)
 2.1-second pause

Stuart Allen 06
Chronotropic Incompetence (CI)
Heart
Rate

Max
Quick
Slow

Unstable
Rest
Time
Start Stop
Activity Activity
Normal
Stuart Allen 06
CI
Who Is at Risk to Develop SSS?
Persons over the age of 65.

Persons who myocardial infarction & who may have

sustained damage to the sinus node.

Persons taking medications for high blood pressure and

other cardiac conditions.

Persons with hyperkalemia and other electrolyte

disorders.
Persons with hypothyroidism.

Persons with sleep apnea.

Children who have undergone corrective surgery (especially

in the upper chambers) for a congenital heart defect.

Persons who have had diphtheria, muscular dystrophy, or

amyloidosis.These are rare causes of SSS.
What Are the Symptoms of SSS?
Palpitations
Disturbed Fainting
sleep

Chest pain Fatigue and

(angina) weakness
Confusion
How Is SSS Treated?
Medical Care
 The only effective medical care in patients with SND is to
correct extrinsic causes.
Surgical Care
 Pacemaker therapy is the only effective surgical care for
patients with chronic symptomatic SND.
 Because the incidence of sudden death in patients with SND
is extremely low and pacemaker therapy does not appear to
affect survival, the major goal of pacemaker therapy in
patients with SND is to relieve symptoms.
Indications for Pacemaker Implantation
Class I Indications
 Sinus node dysfunction with documented symptomatic sinus bradycardia
 Symptomatic chronotropic incompetence
Class II Indications
 Class IIa: Symptomatic patients with sinus node dysfunction and with no
clear association between symptoms and bradycardia
 Class IIb: Chronic heart rate < 30 bpm in minimally symptomatic patients
while awake
Class III Indications
 Asymptomatic sinus node dysfunction

JACC Vol. 31, no. 5 April 1998, 1175-1209