Sick sinus syndrome causes irregular heartbeat, including periods of tachycardia and bradycardia, and can lead to heart failure. It is most common in people over 50 and can be caused by heart surgery or medication. Treatment includes pacemaker implantation and radiofrequency ablation. Symptoms include fainting, dizziness, confusion, angina, shortness of breath, and fatigue. Medications, including over-the-counter ones, should be taken with caution.
Sick sinus syndrome is an inability of the heartbeat to stay in rhythm. This can create tachycardia, periods of heartbeats that are too fast, or bradycardia, periods of heartbeats that are too slow. There may also be a mixture of bradycardia and tachycardia, which is the most dangerous type. In most cases, sick sinus occurs in people over 50, although it can affect people of any age who have had heart surgery.
The most common form of sick sinus is bradycardia. The normal heart tends to regulate itself naturally, sending electrical signals along the sinus node into the heart to essentially tell the heart to beat. Dysfunction of this natural pacemaker can lead to improper electrical signals. This can be caused by scar tissue or gradual degeneration of the sinus node. It is especially common in children with heart defects who have had corrective heart surgery in the upper chambers of the heart. Such surgery can damage the poorly understood sinus node and cause immediate sick sinus bradycardia or bradycardia several years after surgery.
Surgery can also cause sick sinus tachycardia, but it can also result from damage to the heart caused by heart medications such as beta blockers or digitalis. Antiarrhythmic drugs may fix the problem for a short time, but are likely to do further damage to the heart. Sudden arrhythmias, caused by tachycardia, can also cause sudden death.
Sick sinus bradycardia may progress more slowly and initially be completely asymptomatic. As the disease begins to progress, however, it can lead to fainting episodes and eventually heart failure. If sick sinus bradycardia is seen, but it doesn’t seem to affect the patient much, doctors tend to take a wait-and-see approach.
When diseased sinus bradycardia begins to significantly impact a patient’s life, a pacemaker is usually implanted to keep the heart beating at normal sinus rhythm. Pacemaker implantation has a high success rate in treating diseased sinus bradycardia, however, in very young children, the pacemaker must be placed in the abdomen and replaced in the shoulder when the child is older.
Symptoms of sick sinus of any kind can include fainting, dizziness, feeling confused, angina, shortness of breath, or general fatigue. While diseased sinus bradycardia tends to be easy to detect with an ECG or electrocardiogram, tachycardia can be more difficult to detect, because tachycardia occurs in events, rather than continuously.
Some cardiologists use a Holter monitor, which is like a portable ECG that records all of the heart’s rhythms for 24 hours. If this fails to detect a tachycardia episode, an event monitor can be worn for several days. If the patient experiences symptoms, they press a button to record the event. Event monitors are more likely to detect an episode of sick sinus tachycardia, but still may fail to do so. In these cases, the patient will continue to be followed up and may still be scheduled for radiofrequency ablation.
Radiofrequency ablation is performed using a catheter. The sinus node is thoroughly tested for areas that appear to be causing arrhythmias and areas of scar tissue or areas that appear to be responsible for abnormal rhythms are then subjected to high frequency radio waves which essentially kill these areas. This procedure has a good success rate, but patients may still need a defibrillator if there is any concern about the overall effectiveness of the procedure.
Untreated diseased sinus will invariably cause death, although there may be a slow progression from the emergence of symptoms to actual heart failure. Those being treated for any form of sinusitis need to be careful about what types of medications they take. Even some over-the-counter medications can cause abnormal heartbeats. Children with sinusitis should never be treated with Ritalin or any other ADD medication, as these are amphetamines which can severely exacerbate the problem.
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