Sick sinus syndrome electrocardiogram

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

Electrocardiogram

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 testing.

For EKG examples of sick sinus syndrome click here.

File:SSS ecg 001.jpg

Sick Sinus Syndrome - atrial fibrillation (irregularly irregular rhythm) stopping abruptly

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Electrocardiogram shown below is recorded in a middle-aged woman treated for atrial fibrillation. The patient was doing well when this electrocardiogram was taken, and was taking digoxin and flecainide . The electrocardiogram shows an irregular rhythm which appears to be sinus. The grouping of the QRS complexes suggests a Mobitz type I AV block. In this case though, no AV block is seen and this may represent a sinus node exit block.

File:Sinus node exit block.jpg

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EKG shown below is a recording from a middle aged woman with recurrent atrial fibrillation. She was treated with flecainide with some improvement of her symptoms. The above is a recording taken in the cardiac clinic. It shows group beating with sinus rhythm. There are missing P waves. This suggests that there is sinus node arrest or that this is sinus node exit block.

File:Sanodearrest.jpg

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Shown below is an EKG showing the termination of a supraventricular tachycardia at about 130/min. which terminates and leaves a pause and then sinus bradycardia. This is a from of "tachy/brady" syndrome where a tachycardia is followed by a bradycardia.

File:Sick sinus syndrome 1.jpg

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Sources

Copyleft images obtained courtesy of ECGpedia, http://en.ecgpedia.org/index.php?title=Special:NewFiles&dir=prev&offset=20080806182927&limit=500