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Sick Sinus SyndromeAka: Tachycardia-Bradycardia Syndrome, Bradycardia-Tachycardia Syndrome

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  1. Definition
    1. Disorder interfering with sinus node pacing function
  2. Causes
    1. Elderly (mean age 68 years old)
      1. Dysfunction associated with aging
      2. Most cases are idiopathic
      3. Structural heart disease
      4. Myocardial Ischemia (<33% of patients)
    2. Children
      1. Follows Congenital Heart Disease surgical correction
      2. Congenital abnormalities or SA node artery deficiency
  3. Associated conditions
    1. Atrial Fibrillation
    2. Atrioventricular Node Block
  4. Symptoms (associated with sinus pause or Bradycardia)
    1. Palpitations or Angina Pectoris
    2. Fatigue
    3. Confusion or Altered Level of Consciousness
    4. Syncope
    5. Exercise intolerance
    6. Dizziness
  5. Signs: Monitor rhythm while performing procedures
    1. Valsalva response absent or minimal (no pulse increase)
    2. Carotid message induces sinus arrest >3 seconds
  6. Diagnostics: EKG Monitoring
    1. Correlate symptom diary with ambulatory monitoring
      1. Event Monitor or
      2. Holter Monitor for two 24 hour periods
    2. Atrial Bradyarrhythmia (inappropriately)
      1. Sinus Bradycardia
      2. Sinus arrest
      3. Second Degree Heart Block (Mobitz Type I or II)
      4. Atrial Fibrillation with slow ventricular response
    3. Tachycardia (Tachycardia-Bradycardia Syndrome)
      1. Tachycardia alternates with Bradycardia
      2. Associated with Atrial Fibrillation or atrial flutter
    4. Other EKG testing to consider
      1. Exercise Stress Test
      2. Electrophysiology (less commonly indicated)
  7. Differential Diagnosis
    1. Hypothyroidism
    2. Hypothermia
    3. Hypoxia
    4. Hyperkalemia
    5. Cardiomyopathy
    6. Collagen vascular disease
    7. Metastatic cancer
    8. Medications
      1. Digoxin
      2. Quinidine
      3. Amiodarone
      4. Beta Blockers
      5. Diltiazem
      6. Verapamil
      7. Clonidine
  8. Complications
    1. Thromboembolism
    2. Myocardial Infarction
    3. Congestive Heart Failure
    4. Cerbebrovascular Accident
  9. Management
    1. Permanent implantable demand ventricular Pacemaker
      1. Sick Sinus Syndrome accounts for >50% pacers placed
    2. Tachyarrhythmia control (use only with Pacemaker)
      1. Beta Blocker
      2. Calcium Channel Blocker
      3. Digoxin
    3. Anticoagulation with Coumadin
      1. See Anticoagulation in Atrial Fibrillation
      2. Indications
        1. Atrial Fibrillation
        2. Tachycardia-Bradycardia Syndrome
  10. Prognosis
    1. Best prognosis with Sinus Bradycardia only
  11. References
    1. Faddis in Ahya (2001) Washington Manual, p. 153
    2. Behrman (2000) Nelson Pediatrics, p. 1422-3
    3. Wagner (2001) Marriott's Electrocardiography, p. 402
    4. Adan (2003) Am Fam Physician 67(8):1725

Sick Sinus Syndrome (C0037052)

Definition (MSH)A condition caused by dysfunctions related to the SINOATRIAL NODE including impulse generation (CARDIAC SINUS ARREST) and impulse conduction (SINOATRIAL EXIT BLOCK). It is characterized by persistent BRADYCARDIA, chronic ATRIAL FIBRILLATION, and failure to resume sinus rhythm following CARDIOVERSION. This syndrome can be congenital or acquired, particularly after surgical correction for heart defects.
Definition (NCI)A constellation of signs and symptoms which may include syncope, fatigue, dizziness, and alternating periods of bradycardia and atrial tachycardia, which is caused by sinoatrial node dysfunction.
ConceptsDisease or Syndrome (T047)
ICD9427.81
EnglishSick Sinus Syndrome, SYNDROME SICK SINUS
Spanishsíndrome de disfunción sinusal, síndrome del seno enfermo, sindrome de disfuncion sinusal, sindrome del seno enfermo
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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