Sick sinus syndrome. Diagnosis of sick sinus syndrome

This term is called the reduced function of the SA node (reducing automaticity and / or ability to conduct impulses to the atria). Therefore, it appears to ECG signs of sinus bradycardia and / or CA blockade. It is possible that cases of short-range P-R, described in the previous section can be included in this theory.

ECG pattern of sick sinus syndrome (SSS) is often intermittent. So if you suspect that this change should try to find it with a continuous ECG recording (Holter monitoring are hence), and if necessary, to conduct a study of sinus function: automatic and CA of using intracavitary procedures.

Sick sinus syndrome. Diagnosis of sick sinus syndrome

Approximately one-third of such patients have paroxysmal attacks of supraventricular tachycardia, particularly atrial flutter and / or atrial fibrillation (brady-, tahisindrom). This syndrome is a chronic progressive process that creates changes in the ECG to the onset of clinical symptoms. It could be years before they occur, and therefore electrocardiographic signs point to the need to not implant the pacemaker, as was once suggested, but rather the need for follow-up. Patients with sick sinus should be re-Holter monitoring and other studies, because it can cause fainting or sudden death.

When a minor sinus treatment is not required, recommended drugs, which accelerate the heart rate such as salbutamol or hydralazine. However, in the presence of severe forms of the syndrome, brady, tachycardia, pacemaker implantation is shown. The beneficial effects of stimulants of various types of atrial, on-demand AV sequential, or physiological, is manifested in the form of conservation AV synchrony. Prognostic significance of pauses> 3 s, according to the Holter recording, is controversial.

With symptomatic sinus (SSS) are necessary prior EPS. However, these studies should be performed if the SSS is assumed but not confirmed by Holter monitoring. Nevertheless, it should take into account that the gradual increase in recovery time SA node has a questionable clinical significance, and this increase in SA conduction time is a sensitive but not very specific criteria for sick sinus syndrome. Therefore, it is unlikely to contribute to solving the problem of pacemaker implantation. EPS may play a role in patients with asymptomatic sick sinus syndrome, which required kardiodepressiruyuschie drugs. If the time of sinus node (VVSU) prolonged after administration of these drugs (> 2 s), they are used with caution or implanted pacemaker.

According to the Committee of NASPE, intracavitary electrophysiologic studies should be conducted:
a) if there is no causal relationship between the presence of sinus bradycardia, sinus pause, or blockade of the SA node to the output, and clinical symptoms (eg, fainting, or close to it);
b) in patients with SA node dysfunction manifest, which requires implantation of a pacemaker to identify the antegrade and retrograde AV conduction to determine the scope and method of stimulation.

EPS are possible, but not required:
a) after a complicated surgery that affects the atria, and, for example, after the Mustard procedure;
b) to identify the mechanisms that cause dysfunction of the SA node, such as excessive vagotonia to determine the pharmacological treatment of some patients and not with the pacing.

EPS does not show:
a) in asymptomatic patients with sinus bradycardia;
b) if the symptoms are clearly associated with dysfunction of the SA node.