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Manifestations and causes of the sick sinus syndrome

INTRODUCTION

The term "sick sinus syndrome" was first used by Lown in 1967 to describe the sluggish return of sinoatrial (SA) nodal activity in some patients following DC electroversion [1]. The term was later applied to a clinical syndrome characterized by chronic SA nodal dysfunction, a sluggish or absent SA nodal pacemaker after DC electroversion, frequently depressed escape pacemakers, and AV nodal conduction disturbances [2,3]. Another set of manifestations included alternating bradycardia and supraventricular tachycardia (the bradycardia-tachycardia syndrome), commonly with underlying atrial fibrillation (AF) or atrial flutter; these findings were associated with SA nodal dysfunction and, following termination of the tachycardia, severe SA nodal depression in some patients [2,4-9].

The clinical manifestations, causes, and natural history of sick sinus syndrome will be reviewed here. The treatment of this disorder is discussed separately. (See "Treatment of the sick sinus syndrome".)

CLINICAL CHARACTERISTICS

Patients with symptomatic SSS are primarily older, with frequent comorbid diseases and a high mortality rate. In three major trials of pacing in this disorder, the median or mean age was 73 to 76 years [9-11]. Although less common, SSS also occurs in younger adults and children. (See 'Childhood and familial disease' below.)

The sick sinus syndrome is defined by electrocardiographic criteria, since clinical signs and symptoms may be absent or quite varied. Symptoms of lightheadedness, presyncope, or syncope are often the reason that the patient seeks medical attention. Other manifestations include increasing dyspnea on exertion, worsening angina, and, in patients with alternating bradycardia and tachycardia, palpitations and other symptoms associated with a rapid heart rate. (See 'Tachycardia-bradycardia syndrome' below.)

The characteristics of the sick sinus syndrome include:
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