treatment

Last reviewed 01/2018

The management of sick sinus syndrome has three main components:

• permanent pacing:
• used in chronic symptomatic patients
• dual-chamber pacing and single-chamber atrial pacing (in patients with sick sinus syndrome without atrioventricular block), as opposed to single-chamber ventricular pacing, are considered to be ‘physiological’ pacing modes because AV synchrony is maintained and the frequency of contractions of the atria and ventricles varies with metabolic demand, mimicking the heart’s natural rhythm
• dual-chamber pacemakers have pacing leads in the right atrium and ventricle
  • indicated for use in the treatment of atrioventricular block in the absence of continuous atrial fibrillation, and in sick sinus syndrome with atrioventricular block

• anti-arrhythmic drugs may be required to manage any tachyarrhythmia

• anticoagulation:
• thromboembolism is a common complication

Reference:

1. NICE (February 2005).Dual-chamber pacemakers for symptomatic bradycardia due to sick sinus syndrome and/or atrioventricular block
2. Andersen, HR, et al. (1994). Prospective randomised trial of atrial versus ventricular pacing in sick-sinus syndrome. Lancet, 344, 1523-28.