Sick sinus syndrome medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Sick sinus syndrome}} | {{Sick sinus syndrome}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{Sahar}} | ||
==Overview== | ==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. | 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. | ||
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== 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay <ref name="KusumotoSchoenfeld2019">{{cite journal|last1=Kusumoto|first1=Fred M.|last2=Schoenfeld|first2=Mark H.|last3=Barrett|first3=Coletta|last4=Edgerton|first4=James R.|last5=Ellenbogen|first5=Kenneth A.|last6=Gold|first6=Michael R.|last7=Goldschlager|first7=Nora F.|last8=Hamilton|first8=Robert M.|last9=Joglar|first9=José A.|last10=Kim|first10=Robert J.|last11=Lee|first11=Richard|last12=Marine|first12=Joseph E.|last13=McLeod|first13=Christopher J.|last14=Oken|first14=Keith R.|last15=Patton|first15=Kristen K.|last16=Pellegrini|first16=Cara N.|last17=Selzman|first17=Kimberly A.|last18=Thompson|first18=Annemarie|last19=Varosy|first19=Paul D.|title=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|journal=Circulation|volume=140|issue=8|year=2019|issn=0009-7322|doi=10.1161/CIR.0000000000000627}}</ref> == | == 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay <ref name="KusumotoSchoenfeld2019">{{cite journal|last1=Kusumoto|first1=Fred M.|last2=Schoenfeld|first2=Mark H.|last3=Barrett|first3=Coletta|last4=Edgerton|first4=James R.|last5=Ellenbogen|first5=Kenneth A.|last6=Gold|first6=Michael R.|last7=Goldschlager|first7=Nora F.|last8=Hamilton|first8=Robert M.|last9=Joglar|first9=José A.|last10=Kim|first10=Robert J.|last11=Lee|first11=Richard|last12=Marine|first12=Joseph E.|last13=McLeod|first13=Christopher J.|last14=Oken|first14=Keith R.|last15=Patton|first15=Kristen K.|last16=Pellegrini|first16=Cara N.|last17=Selzman|first17=Kimberly A.|last18=Thompson|first18=Annemarie|last19=Varosy|first19=Paul D.|title=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|journal=Circulation|volume=140|issue=8|year=2019|issn=0009-7322|doi=10.1161/CIR.0000000000000627}}</ref> == | ||
=== Acute Management of Reversible Causes of Sinus Node Dysfunction === | |||
{|class="wikitable" | |||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In symptomatic patients presenting with sinus node dysfunction (SND), evaluation and treatment of reversible causes is recommended. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
|} | |||
=== Acute Medical Therapy for Bradycardia=== | === Acute Medical Therapy for Bradycardia=== | ||
{|class="wikitable" | {|class="wikitable" | ||
Revision as of 22:34, 8 April 2020
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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 |
| "In patients with SND associated with symptoms or hemodynamic compromise, atropine is reasonable to increase sinus rate (Level of Evidence: C)"[3] |
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.