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. Atropine may be used in the presence of symptoms or hemodynamic compromise.
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:
- Patients with documented bradycardia and are symptomatic
- Patients with chronotropic incompetence
- Sinus node dysfunction secondary to medications necessitated by another medical condition
- Patients with heart rate < 40 per minute
- 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.
- Atropine may be used in the presence of symptoms or hemodynamic compromise.
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] |
| Class IIb |
| "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] |
| Class III (No Benefit) |
| "3. In patients who have undergone heart transplant without evidence for autonomic reinnervation, atropine should not be used to treat sinus bradycardia. (Level of Evidence: C)"[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.
- ↑ Gee, Samantha W.; Karsies, Todd J. (2015). "Listeria meningitis–associated bradyarrhythmia treated with isoproterenol". The American Journal of Emergency Medicine. 33 (2): 306.e1–306.e2. doi:10.1016/j.ajem.2014.06.022. ISSN 0735-6757.
- ↑ Morrison, Laurie J.; Long, Jennifer; Vermeulen, Marian; Schwartz, Brian; Sawadsky, Bruce; Frank, Jamie; Cameron, Bruce; Burgess, Robert; Shield, Jennifer; Bagley, Paul; Mausz, Vivien; Brewer, James E.; Dorian, Paul (2008). "A randomized controlled feasibility trial comparing safety and effectiveness of prehospital pacing versus conventional treatment: 'PrePACE'". Resuscitation. 76 (3): 341–349. doi:10.1016/j.resuscitation.2007.08.008. ISSN 0300-9572.
- ↑ Bernheim, Alain; Fatio, Renate; Kiowski, Wolfgang; Weilenmann, Daniel; Rickli, Hans; Rocca, Hans Peter Brunner-La (2004). "ATROPINE OFTEN RESULTS IN COMPLETE ATRIOVENTRICULAR BLOCK OR SINUS ARREST AFTER CARDIAC TRANSPLANTATION: AN UNPREDICTABLE AND DOSE-INDEPENDENT PHENOMENON". Transplantation. 77 (8): 1181–1185. doi:10.1097/01.TP.0000122416.70287.D9. ISSN 0041-1337.
- ↑ Link, Mark S.; Berkow, Lauren C.; Kudenchuk, Peter J.; Halperin, Henry R.; Hess, Erik P.; Moitra, Vivek K.; Neumar, Robert W.; O’Neil, Brian J.; Paxton, James H.; Silvers, Scott M.; White, Roger D.; Yannopoulos, Demetris; Donnino, Michael W. (2015). "Part 7: Adult Advanced Cardiovascular Life Support". Circulation. 132 (18 suppl 2): S444–S464. doi:10.1161/CIR.0000000000000261. ISSN 0009-7322.