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sick sinus syndrome; atrial fibrillation with bradyarrhythmia; tachycardia-bradycardia syndrome

Etiology: - fibrosis, inflammation or degenerative changes involving the sinoatrial (sinus) node & atria Epidemiology: - occurs most often in the elderly with underlying heart disease or previous cardiac surgery - can occur in the fetus, infant, or child without heart disease or other contributing factors, in which case it is considered a congenital disorder Genetics: - autosomal recessive - associated with mutations in SCN5A gene (type 1) - associated with defects in HCN4 (type 2) Clinical manifestations: 1) dizziness 2) weakness 3) palpitations 4) syncope or near syncope Special laboratory: - electrocardiogram - sinus bradycardia, sinus arrest, &/or sinoatrial block - episodes of atrial tachycardia (including atrial fibrillation) coexisting with sinus bradycardia ('tachy-brady syndrome') are also common Management: 1) pharmacologic agents to control supraventricular tachycardia 2) consider pacemaker for symptomatic bradycardia or sinus arrest/pause [NGC (NICE)] 3) pacemaker implantation may be necessary in order to safely administer medications to control the ventricular response to atrial fibrillation 4) minimal pacing of right ventricle may diminishe incidence of atrial fibrillation [4]

Related

sinoatrial exit block sinus arrest/pause sinus arrhythmia

General

supraventricular arrhythmia chronic cardiac arrhythmia bradyarrhythmia (bradycardia)

Database Correlations

OMIM correlations

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 272
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 16. American College of Physicians, Philadelphia 1998, 2012
  3. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
  4. Sweeney MO et al, for the Search AV Extension and Managed Ventricular Pacing for Promoting Atrioventricular Conduction (SAVE PACe) Trial Minimizing ventricular pacing to reduce atrial fibrillation in sinus-node disease. N Engl J Med 2007, 357:1000 PMID: 17804844