Sick sinus syndrome
| Classification according to ICD-10 | |
|---|---|
| I49.5 | Sick sinus syndrome |
| ICD-10 online (WHO version 2019) | |
The term sick sinus syndrome ( synonyms : sinus node syndrome , sinus node disease , syndrome of the sick sinus node ) summarizes various cardiac arrhythmias that are based on malfunctions of the sinus node and the conduction of excitation at the atrial level. Sick sinus syndrome mostly affects people over the age of 50 and is probably equally common in men and women. In German hospitals it was mentioned in 2017 as an indication for 35% of the approximately 78,000 pacemaker implantations .
Cause of sick sinus syndrome is often a non-specific scarring degeneration in the conduction system of the heart or a mechanical stretching of the atria. In children, it is often observed after operations in the right atrium for congenital heart defects, especially after Fontan's surgery (but this decreases with increasing experience).
Definition and use of the term
The term sick sinus syndrome was coined in 1962 by the American cardiologist Bernard Lown . A generally accepted definition of the sick sinus syndrome does not yet exist. Theoretically, the diagnosis can be made if at least one of the typical findings has been detected in the electrocardiogram :
- inadequate sinus bradycardia without any other cause,
- Sinus node arrest ,
- sinoatrial block ,
- Atrial fibrillation ,
- Atrial flutter and
- supraventricular tachycardias .
Since these rhythm disturbances, which are part of the syndrome, are treated differently, it is unusual to use the common term sick sinus syndrome to describe them. The term is usually only used in special circumstances, in particular
- in the combined occurrence of arrhythmias with pronounced low and high pulse rates ( tachycardia-bradycardia syndrome ) and
- for traditional reasons to justify cardiac pacemaker therapy in sinus bradycardia, sinus node arrest or sinus atrial block.
Classification according to the type of arrhythmia
- Sinus arrest
- SA block
- Sinus bradycardia
- Supraventricular extra beats
- Supraventricular tachycardia
- Atrial fibrillation
- Atrial flutter
- Bradycardia-Tachycardia Syndrome
causes
The most common cause of sick sinus syndrome is probably arterial hypertension , which leads to chronic pressure load on the atria and then to overstretching of the muscle fibers.
Other causes are:
- Sick sinus syndrome with no apparent structural heart disease
- in myocarditis
- in case of intoxication
- with atrial overstretch
- for hypertensive heart disease
- with mitral valve defects
- for tricuspid valve defects
- with pulmonary hypertension
- in constrictive pericarditis
- with coronary heart disease
- with circulatory disorder of the sinus node and the atrium
- without circulatory disorders of the sinus node and the atrium
Investigation options
The decisive examination method for the detection of the sick sinus syndrome is the long-term ECG . An echocardiography is also useful . An atropine test , an exercise ECG, a long-term blood pressure measurement or a cardiac catheter examination are less necessary . A special, very complex examination method of the sick sinus syndrome is the electrophysiological examination.
therapy
In principle, a cardiac pacemaker must be implanted in a chronic sick sinus syndrome with symptomatic bradycardias or breaks of more than 3 seconds , whereby DDD systems are mostly used.
In addition to treating the underlying disease, beta blockers , dronedarone or amiodarone can be useful to maintain the sinus rhythm after pacemaker implantation .
In the acute phase, negative chronotropic medication should be avoided at all because of the risk of inducing breaks or symptomatic bradycardias . In the acute phase of symptomatic bradycardia or incipient heart failure, atropine 0.5 mg intravenously , or alternatively (outside of the approval for off-label use ) orciprenaline intravenously 1–3 micrograms. If an enlargement of the atrium is detectable and atrial fibrillation is present, anticoagulation should be initiated. In the case of bradycardia forms of the sick sinus syndrome, the implantation of a pacemaker is useful. A catheter ablation is far sinus syndrome Sick rarely performed at.
See also
literature
- V. Adan, LA Crown: Diagnosis and Treatment of Sick Sinus Syndrome. In: Am Fam Physician. (2003); 67, pp. 1725-1732. PMID 12725451
Individual evidence
- ↑ Markewitz A. Annual Report 2017 of the German Pacemaker and Defibrillator Register - Part 1: Pacemaker. Herzschr Elektrophys 2019, 30: 389–403, https://doi.org/10.1007/s00399-019-00648-9
