Sick Sinus Syndrome (SSS)

Introduction

Sick Sinus Syndrome (SSS) is a group of heart rhythm disorders that originate from the sinoatrial (SA) node, the natural pacemaker of the heart. It is more common in elderly individuals and can lead to serious complications if left untreated.

Causes

SSS is usually caused by: - Degeneration of the SA node due to aging - Ischemic heart disease (coronary artery disease) - Inflammatory or infiltrative disease (e.g., amyloidosis, sarcoidosis) - Autonomic dysfunction - Medication effects (beta-blockers, calcium-channel blockers)

Symptoms

Symptoms of SSS can vary and include: - Fatigue - Dizziness or lightheadedness - Syncope (fainting) - Palpitations (irregular heartbeats) - Chest pain (angina) - Shortness of breath

Types of Sick Sinus Syndrome

1. Sinus Bradycardia – Abnormally slow heart rate
2. Tachycardia-Bradycardia Syndrome – Alternating slow and fast heart rate
3. Sinoatrial Block – Disrupted electrical signaling between the SA node and atria
4. Sinus Arrest – Complete pause in sinus node activity

Diagnosis

Diagnosis of SSS includes: - Electrocardiogram (ECG) – Detects irregular rhythms - Holter monitoring – Monitors heart rhythm over 24-48 hours - Event recorder – Used for intermittent symptoms - Electrophysiological study (EPS) – Maps electrical activity

Treatment

Treatment of SSS depends on severity: - Mild or asymptomatic cases – Monitoring and medication adjustments - Severe cases – A pacemaker implantation is often the treatment of choice - Medication management – Antiarrhythmic drugs may be needed for associated atrial fibrillation

Prognosis

With proper treatment, most patients with SSS can live a normal life. Pacemaker implantation significantly improves symptoms and reduces complications.

Key Takeaways

• SSS is a disorder of the heart's pacemaker function
• Symptoms range from mild fatigue to fainting
• Diagnosis relies on ECG and long-term monitoring
• Treatment includes pacemakers for severe cases

Conclusion

Sick Sinus Syndrome is a manageable condition with modern cardiology. Early detection and treatment improve quality of life and prevent serious complications.

Source recommendations

1. American College of Cardiology/American Heart Association (ACC/AHA) Guidelines on the Management of Bradycardia

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000628
2. https://www.jacc.org/guidelines/bradycardia
3. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2018/11/05/15/12/2018-acc-aha-hrs-guideline-on-bradycardia
4. https://pubmed.ncbi.nlm.nih.gov/30586772/
5. https://www.heartrhythmjournal.com/article/S1547-5271(18)31127-5/fulltext

2. European Society of Cardiology (ESC) Guidelines on Cardiac Pacing and Resynchronization Therapy

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Cardiac-Pacing-and-Cardiac-Resynchronization-Therapy
2. https://academic.oup.com/eurheartj/article/42/35/3427/6358547
3. https://pubmed.ncbi.nlm.nih.gov/34455430/
4. https://academic.oup.com/eurheartj/article/34/29/2281/401445
5. https://pubmed.ncbi.nlm.nih.gov/23801827/