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sinus arrest/pause
A pause in or arrest of sinus activity. The p-p interval of the pause should not be a multiple (i.e. 2X, 3X etc.) of the baseline p-p interval (See sinoatrial exit block).
Etiology:
1) excess vagal tone
- syncope due to neurocardiogenic vasodepressor dysfunction
2) pharmacologic agents
- digitalis toxicity
3) degenerative fibrotic changes
4) acute myocardial infarction
5) electrolyte imbalances
Clinical manifestations:
1) lightheadedness
2) dizziness
3) syncope or presyncope
Management:
1) correct underlying cause
2) consider permanent cardiac pacemaker if pause > 3 seconds
- pacemaker reduces recurrence of syncope [2]
Related
sick sinus syndrome; atrial fibrillation with bradyarrhythmia; tachycardia-bradycardia syndrome
sinoatrial exit block
sinus arrhythmia
General
sinus bradycardia
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 272
- Brignole M et al.
Pacemaker therapy in patients with neurally mediated syncope
and documented asystole: Third International Study on Syncope
of Uncertain Etiology (ISSUE-3). A randomized trial.
Circulation 2012 May 29; 125:2566
PMID: 22565936
- Connolly SJ.
Permanent pacemaker therapy for neurally mediated syncope.
Circulation 2012 May 29; 125:2552.
PMID: 22565938