Management of sinus node dysfunction

Management of sinus node dysfunction

Asymptomatic bradycardia or pauses and with no associated episodes of atrial fibrillation needs no treatment. In symptomatic patients with sinus nodal dysfunction and atrial fibrillation therapy depends on whether symptoms are related to the tachycardia or bradycardia. Pacing is useful to prevent bradycardia. Drugs known to depress sinus node function should be stopped or back up pacing will be needed. Anticoagulation should be considered for atrial fibrillation.

Pacing for sinus node dysfunction

Sinus node dysfunction is the most common indication for pacemaker implantation. Atrial pacing can decrease incidence of atrial fibrillation. Symptomatic patients should be considered for dual-chamber pacemaker implantation. Ventricular pacing is considered for patients with chronic atrial fibrillation. Atrial pacemaker may be enough if the AV conduction is intact. Occurence of new AV conduction abnormalities develop at a rate 2.7% / year has to be borne in mind while planning purely atrial based pacing. Rate-adaptive pacing and mode switching important functions which could be useful.