Sick sinus syndrome surgery

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

Surgery and Device-based Therapy

ACC/AHA Guidelines- Recommendations for Permanent Pacing in Sinus node Dysfunction

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Class I Permanent pacemaker implantation is indicated for SND with documented symptomatic bradycardia, including frequent sinus pauses that produce symptoms. (Level of Evidence: C) Permanent pacemaker implantation is indicated for symptomatic chronotropic incompetence. (Level of Evidence:C) Permanent pacemaker implantation is indicated for symptomatic sinus bradycardia that results from required drug therapy for medical conditions.(Level of Evidence: C)

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Class III Permanent pacemaker implantation is not indicated for SND in asymptomatic patients. (Level of Evidence: C) Permanent pacemaker implantation is not indicated for SND in patients for whom the symptoms suggestive of bradycardia have been clearly documented to occur in the absence of bradycardia. (Level of Evidence: C) Permanent pacemaker implantation is not indicated for SND with symptomatic bradycardia due to nonessential drug therapy. (Level of Evidence: C)

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Class IIa Permanent pacemaker implantation is reasonable for SND with heart rate less than 40 bpm when a clear association between significant symptoms consistent with bradycardia and the actual presence of bradycardia has not been documented. (Level of Evidence: C) Permanent pacemaker implantation is reasonable for syncope of unexplained origin when clinically significant abnormalities of sinus node function are discovered or provoked in electrophysiological studies. (Level of Evidence: C)

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Class IIb Permanent pacemaker implantation may be considered in minimally symptomatic patients with chronic heart rate less than 40 bpm while awake. (Level of Evidence: C)

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Bradyarrhythmias are well controlled with pacemakers, while tachyarrhythmias respond well to medical therapy. However, because both bradyarrhythmias and tachyarrhythmias may be present, drugs to control tachyarrhythmia may exacerbate bradyarrhythmia. Therefore, a pacemaker is implanted before drug therapy is begun for the tachyarrhythmia.