Materiały źródłowe

• #1 Sick Sinus Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK470599/

  Sick sinus syndrome, also known as sinus node dysfunction, is a disorder of the sinoatrial node caused by impaired pacemaker function and impulse transmission producing a constellation of abnormal rhythms. […] Sick sinus syndrome, also known as sinus node dysfunction (SND), is a disorder of the sinoatrial (SA) node caused by impaired pacemaker function and impulse transmission producing a constellation of abnormal rhythms. […] The etiologic factors leading to sinus node dysfunction can be classified into two categories: intrinsic pathology to the sinus node itself, typically results from fibrosis of the nodal tissue and external causes that affect the SA node function. […] While the most common intrinsic factor leading to sinus node dysfunction is age-related degeneration of the SA node, sinus node dysfunction can be a result of congenital disorders, arrhythmias, infiltrative disorders and surgery.

• #2 Sick Sinus Syndrome: A Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0515/p691.html/1000

  Sick sinus syndrome refers to a collection of disorders marked by the heart’s inability to perform its pacemaking function. Sick sinus syndrome results from intrinsic causes, or may be exacerbated or mimicked by extrinsic factors. Intrinsic causes include degenerative fibrosis, ion channel dysfunction, and remodeling of the sinoatrial node. […] Intrinsic causes of sick sinus syndrome include degenerative fibrosis of the sinoatrial node, ion channel dysfunction, and remodeling of the sinoatrial node. […] Recent research and understanding of familial and congenital sick sinus syndromes, however, have shown that an inherited dysfunction of ion channels within the sinoatrial node also plays a significant part in age-related sick sinus syndrome. […] Remodeling of the sinoatrial node occurs in heart failure and atrial fibrillation, and this appears to play a role in the development of sick sinus syndrome for some patients.

• #3 Sick Sinus Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29012

  Sick sinus syndrome, also known as sinus node dysfunction (SND), is a disorder of the sinoatrial (SA) node caused by impaired pacemaker function and impulse transmission producing a constellation of abnormal rhythms. These include atrial bradyarrhythmias, atrial tachyarrhythmias and, sometimes, bradycardia alternating with tachycardia often referred to as tachy-brady syndrome. […] The etiologic factors leading to sinus node dysfunction can be classified into two categories: intrinsic pathology to the sinus node itself, typically results from fibrosis of the nodal tissue and external causes that affect the SA node function. […] While the most common intrinsic factor leading to sinus node dysfunction is age-related degeneration of the SA node, sinus node dysfunction can be a result of congenital disorders, arrhythmias, infiltrative disorders and surgery. Recent studies have identified several mutations in the ion channels explaining familial and congenital forms of sick sinus syndrome. Heart failure and atrial tachyarrhythmias have been shown to induce cellular remodeling of the sinus node in animal models.

• #4 Sick Sinus Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK470599/

  Sick sinus syndrome, also known as sinus node dysfunction, is a disorder of the sinoatrial node caused by impaired pacemaker function and impulse transmission producing a constellation of abnormal rhythms. […] Sick sinus syndrome, also known as sinus node dysfunction (SND), is a disorder of the sinoatrial (SA) node caused by impaired pacemaker function and impulse transmission producing a constellation of abnormal rhythms. […] The etiologic factors leading to sinus node dysfunction can be classified into two categories: intrinsic pathology to the sinus node itself, typically results from fibrosis of the nodal tissue and external causes that affect the SA node function. […] While the most common intrinsic factor leading to sinus node dysfunction is age-related degeneration of the SA node, sinus node dysfunction can be a result of congenital disorders, arrhythmias, infiltrative disorders and surgery.

• #5 Sick Sinus Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29012

  Sick sinus syndrome, also known as sinus node dysfunction (SND), is a disorder of the sinoatrial (SA) node caused by impaired pacemaker function and impulse transmission producing a constellation of abnormal rhythms. These include atrial bradyarrhythmias, atrial tachyarrhythmias and, sometimes, bradycardia alternating with tachycardia often referred to as tachy-brady syndrome. […] The etiologic factors leading to sinus node dysfunction can be classified into two categories: intrinsic pathology to the sinus node itself, typically results from fibrosis of the nodal tissue and external causes that affect the SA node function. […] While the most common intrinsic factor leading to sinus node dysfunction is age-related degeneration of the SA node, sinus node dysfunction can be a result of congenital disorders, arrhythmias, infiltrative disorders and surgery. Recent studies have identified several mutations in the ion channels explaining familial and congenital forms of sick sinus syndrome. Heart failure and atrial tachyarrhythmias have been shown to induce cellular remodeling of the sinus node in animal models.

• #6 Sick Sinus Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK470599/

  Sick sinus syndrome, also known as sinus node dysfunction, is a disorder of the sinoatrial node caused by impaired pacemaker function and impulse transmission producing a constellation of abnormal rhythms. […] Sick sinus syndrome, also known as sinus node dysfunction (SND), is a disorder of the sinoatrial (SA) node caused by impaired pacemaker function and impulse transmission producing a constellation of abnormal rhythms. […] The etiologic factors leading to sinus node dysfunction can be classified into two categories: intrinsic pathology to the sinus node itself, typically results from fibrosis of the nodal tissue and external causes that affect the SA node function. […] While the most common intrinsic factor leading to sinus node dysfunction is age-related degeneration of the SA node, sinus node dysfunction can be a result of congenital disorders, arrhythmias, infiltrative disorders and surgery.

• #7

  https://journals.lww.com/md-journal/fulltext/2024/10250/the_effect_of_unhealthy_lifestyle_on_the.44.aspx

  The primary cause of the increased frequency of SSS in older adults is sinus node fibrosis, which is brought on by tissue deterioration in the sinus nodes. […] The pathophysiology of SSS is caused by the process of sinus node fibrosis, which also has an impact on the sinus nodes conduction system. […] All unhealthy lifestyles and the effects of stress result in intrinsic pathological mechanisms that lead to secondary alterations such as hypertension, oxidative stress, inflammation, myocardial fibrosis, and so forth. […] The primary goal of this study was to examine how abnormalities in psychological state caused by various stressors, with a common poor lifestyle, moderated the effects of SSS development. […] Although the specific mechanism of how the mental factors associated with different stressors lead to the occurrence of SSS has not been clarified. But for a long time, endocrine and metabolic disorders caused by various mental stimulation may be the pathogenesis of SSS.

• #8 Sick sinus syndrome pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Sick_sinus_syndrome_pathophysiology

  Sick sinus syndrome occurs as an improperly propagated signal from the sinoatrial (SA) node. Age-dependent progressive fibrosis of the sinus nodal tissue and Remodeling of sinuatrial node are the potential mechanisms of this abnormally formed signal propagation. MYH6 gene may also be involved in the pathogenesis of this condition. […] Sick sinus syndrome occurs as the result of age-dependent progressive fibrosis of the sinus nodal tissue and atrial myocardium. This leads to abnormal formation and propagation of atrial impulse and the resultant bradycardic or pause-related syndromes. […] Studies on familial and congenital presentations of sick sinus syndrome have also revealed genetic contributions to dysfunctional ion channels. […] Remodeling of sinuatrial node as a result of heart failure and atrial fibrillation can also be causes of increased sinus node recovery time, abnormal propagation of the action potential from the node and changes in nodal sensitivity. […] Genes involved in the pathogenesis of sick sinus syndrome include: MYH6 gene: recent research has shown a higher incidence of SSS in carriers of a rare variant of the MYH6 gene, which encodes the alpha heavy chain subunit of cardiac myosin.

• #9 Sick Sinus Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29012

  Sick sinus syndrome, also known as sinus node dysfunction (SND), is a disorder of the sinoatrial (SA) node caused by impaired pacemaker function and impulse transmission producing a constellation of abnormal rhythms. These include atrial bradyarrhythmias, atrial tachyarrhythmias and, sometimes, bradycardia alternating with tachycardia often referred to as tachy-brady syndrome. […] The etiologic factors leading to sinus node dysfunction can be classified into two categories: intrinsic pathology to the sinus node itself, typically results from fibrosis of the nodal tissue and external causes that affect the SA node function. […] While the most common intrinsic factor leading to sinus node dysfunction is age-related degeneration of the SA node, sinus node dysfunction can be a result of congenital disorders, arrhythmias, infiltrative disorders and surgery. Recent studies have identified several mutations in the ion channels explaining familial and congenital forms of sick sinus syndrome. Heart failure and atrial tachyarrhythmias have been shown to induce cellular remodeling of the sinus node in animal models.

• #10 Sick Sinus Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK470599/

  Sick sinus syndrome, also known as sinus node dysfunction, is a disorder of the sinoatrial node caused by impaired pacemaker function and impulse transmission producing a constellation of abnormal rhythms. […] Sick sinus syndrome, also known as sinus node dysfunction (SND), is a disorder of the sinoatrial (SA) node caused by impaired pacemaker function and impulse transmission producing a constellation of abnormal rhythms. […] The etiologic factors leading to sinus node dysfunction can be classified into two categories: intrinsic pathology to the sinus node itself, typically results from fibrosis of the nodal tissue and external causes that affect the SA node function. […] While the most common intrinsic factor leading to sinus node dysfunction is age-related degeneration of the SA node, sinus node dysfunction can be a result of congenital disorders, arrhythmias, infiltrative disorders and surgery.

• #11 Sick Sinus Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29012

  Sick sinus syndrome, also known as sinus node dysfunction (SND), is a disorder of the sinoatrial (SA) node caused by impaired pacemaker function and impulse transmission producing a constellation of abnormal rhythms. These include atrial bradyarrhythmias, atrial tachyarrhythmias and, sometimes, bradycardia alternating with tachycardia often referred to as tachy-brady syndrome. […] The etiologic factors leading to sinus node dysfunction can be classified into two categories: intrinsic pathology to the sinus node itself, typically results from fibrosis of the nodal tissue and external causes that affect the SA node function. […] While the most common intrinsic factor leading to sinus node dysfunction is age-related degeneration of the SA node, sinus node dysfunction can be a result of congenital disorders, arrhythmias, infiltrative disorders and surgery. Recent studies have identified several mutations in the ion channels explaining familial and congenital forms of sick sinus syndrome. Heart failure and atrial tachyarrhythmias have been shown to induce cellular remodeling of the sinus node in animal models.

• #12 Sick sinus syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sick-sinus-syndrome/symptoms-causes/syc-20377554

  Sick sinus syndrome is a type of heart rhythm disorder. It affects the heart’s natural pacemaker (sinus node), which controls the heartbeat. Sick sinus syndrome causes slow heartbeats, pauses (long periods between heartbeats) or irregular heartbeats (arrhythmias). […] In sick sinus syndrome, the electrical signals are irregularly paced. The heartbeat can be too fast, too slow, interrupted by long pauses or an alternating combination of these rhythm issues. Sick sinus syndrome is relatively uncommon, but the risk of developing it increases with age. […] Causes of sick sinus node syndrome can include: Age-related wear and tear of heart tissues, Damage to the sinus node or scarring from heart surgery, Heart disease, Inflammatory diseases affecting the heart, Medications to treat high blood pressure, including calcium channel blockers and beta blockers, Medications to treat irregular heartbeats (arrhythmias), Some Alzheimer’s disease medications, Neuromuscular diseases, such as muscular dystrophy, Obstructive sleep apnea, Rare genetic changes.

• #13 Sinus Node Dysfunction: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/158064-overview

  Abnormal automaticity, or sinus arrest, refers to a failure of sinus impulse generation. Abnormal conduction, or SA delay or block, is a failure of impulse transmission. In such cases, the sinus impulse is generated normally, but it is abnormally conducted to the neighboring atrial tissue. Both abnormal automaticity and abnormal conduction may result from one of several different mechanisms, including fibrosis, atherosclerosis, and inflammatory or infiltrative myocardial processes. […] The most common cause of SND/sick sinus syndrome (SSS) is the replacement of sinus node (SN) tissue by fibrous tissue, which may be accompanied by degeneration and fibrosis of other parts of the conduction system as well, including the atrioventricular (AV) node. […] Local cardiac pathology, systemic diseases that involve the heart, and medications or toxins can all be responsible for abnormal SA node function and may result in SND.

• #14 Sick Sinus Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK470599/

  Recent studies have identified several mutations in the ion channels explaining familial and congenital forms of sick sinus syndrome. […] Heart failure and atrial tachyarrhythmias have been shown to induce cellular remodeling of the sinus node in animal models. […] Several external causes that can affect the pacing function of the SA node. […] The sinoatrial (SA) node is composed of a collection of atrial myocytes that are specialized into two different functional cells. […] Dysfunction of these cells leads to the several arrhythmias: […] The natural history of sinus node dysfunction is usually a slow progression over decades. […] Sinus pauses or severe bradycardia results in central nervous system (CNS) underperfusion which manifests in paroxysmal presyncope or syncope. […] The management of sinus node dysfunction includes identifying and correcting reversible factors, as an initial step.

• #15

  https://www.jci.org/articles/view/18062

  Sick sinus syndrome (SSS) describes an arrhythmia phenotype attributed to sinus node dysfunction and diagnosed by electrocardiographic demonstration of sinus bradycardia or sinus arrest. […] Based on prior associations with disorders of cardiac rhythm and conduction, we screened the subunit of the cardiac sodium channel (SCN5A) as a candidate gene in ten pediatric patients from seven families who were diagnosed with congenital SSS during the first decade of life. […] Compound heterozygous SCN5A mutations were found in five individuals from three families, indicating that congenital SSS may, in some families, segregate as a recessive disorder of the cardiac sodium channel. […] Here we demonstrate that SCN5A mutations explain a recessive disorder of cardiac conduction characterized by bradycardia progressing to atrial inexcitability during the first decade of life.

• #16 Sick sinus syndrome: MedlinePlus GeneticsLock

  https://medlineplus.gov/genetics/condition/sick-sinus-syndrome/

  Genetic changes are an uncommon cause of sick sinus syndrome. Mutations in two genes, SCN5A and HCN4, have been found to cause the condition in a small number of families. These genes provide instructions for making proteins called ion channels that transport positively charged atoms (ions) into cardiac cells, including cells that make up the SA node. The flow of these ions is essential for creating the electrical impulses that start each heartbeat and coordinate contraction of the cardiac muscle. Mutations in these genes reduce the flow of ions, which alters the SA node’s ability to create and spread electrical signals. These changes lead to abnormal heartbeats and the other symptoms of sick sinus syndrome. […] A particular variation in another gene, MYH6, appears to increase the risk of developing sick sinus syndrome. The protein produced from the MYH6 gene forms part of a larger protein called myosin, which generates the mechanical force needed for cardiac muscle to contract. Researchers believe that the MYH6 gene variation changes the structure of myosin, which can affect cardiac muscle contraction and increase the likelihood of developing an abnormal heartbeat.

• #17

  https://omim.org/entry/163800

  A number sign (#) is used with this entry because of evidence that sick sinus syndrome-2 (SSS2) is caused by heterozygous mutation in the cardiac pacemaker channel gene HCN4 (605206) on chromosome 15q24. […] Sick sinus syndrome-2 shows an autosomal dominant pattern of inheritance (Schulze-Bahr et al., 2003). […] In a 66-year-old woman with marked sinus bradycardia (41 bpm) and intermittent atrial fibrillation who suffered a severe syncopal episode, Schulze-Bahr et al. (2003) identified heterozygosity for a 1-bp deletion (605206.0002) in the pacemaker channel gene HCN4. […] In a 43-year-old woman with syncope and a 24-hour ECG showing severe bradycardia (39 bpm on average), cardiac arrest for 40 seconds followed by polymorphic ventricular tachycardia and torsade de pointes, Ueda et al. (2004) identified heterozygosity for a mutation (D553N; 605206.0003) in the HCN4 gene.

• #18 Frontiers | Trends in research on sick sinus syndrome: A bibliometric analysis from 2000 to 2022

  https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.991503/full

  The pathogenesis of SSS is related to many risk factors. […] The function of the sinus node decreased with age, leading to an increase in the incidence of sinus node dysfunction and the number of pacemaker implantation in the elderly. […] Atrial fibrillation and SSS often coexist, and they induce and perpetuate each other. […] Heart failure was a major risk factors for secondary sinus node dysfunction, the mechanism of which may be related to gene mutation in HCN4, a Na + /K + hyperpolarization-activated cyclic nucleotide-gated (HCN) channels that was a molecular marker of functional sinus node cell activity and played a key role in the pacemaker potential. […] The pathogenesis of SSS is associated with obesity, hypertensive heart disease, and autonomic neuropathy.

• #19 Sick sinus syndrome: MedlinePlus GeneticsLock

  https://medlineplus.gov/genetics/condition/sick-sinus-syndrome/

  Genetic changes are an uncommon cause of sick sinus syndrome. Mutations in two genes, SCN5A and HCN4, have been found to cause the condition in a small number of families. These genes provide instructions for making proteins called ion channels that transport positively charged atoms (ions) into cardiac cells, including cells that make up the SA node. The flow of these ions is essential for creating the electrical impulses that start each heartbeat and coordinate contraction of the cardiac muscle. Mutations in these genes reduce the flow of ions, which alters the SA node’s ability to create and spread electrical signals. These changes lead to abnormal heartbeats and the other symptoms of sick sinus syndrome. […] A particular variation in another gene, MYH6, appears to increase the risk of developing sick sinus syndrome. The protein produced from the MYH6 gene forms part of a larger protein called myosin, which generates the mechanical force needed for cardiac muscle to contract. Researchers believe that the MYH6 gene variation changes the structure of myosin, which can affect cardiac muscle contraction and increase the likelihood of developing an abnormal heartbeat.

• #20 Sick Sinus Syndrome | Thoracic Key

  https://thoracickey.com/sick-sinus-syndrome-2/

  Electrocardiographic manifestations of sick sinus syndrome Sinus bradycardia Extreme sinus arrhythmia Tachycardiabradycardia syndrome Sinoatrial exit block Sinus pause/sinus arrest Sinoatrial reentrant tachycardia Electrocardiographic findings associated with sick sinus syndrome Intra-atrial reentrant tachycardia (IART) Atrial fibrillation AV nodal dysfunction […] Conditions associated with a high prevalence of sick sinus syndrome include atrial repair of d-transposition of the great arteries, complete repair for anomalous pulmonary venous drainage, atrial septal defect, and single ventricle palliation with the Fontan operation, although almost any open heart repair may result in sinus node impairment. Sinus node malformation is associated with left atrial isomerism and sinus node dysfunction may coexist with congenital complete heart block. Congenital sinus node dysfunction due to SCN5a mutation and perhaps mutations in other cardiac genes (e.g., the MYH6 gene encoding the cardiac aloha heavy chain subunit of myosin) along with congenital central hypoventilation syndrome with sinus node dysfunction are rare but have been reported. Familial clustering has been reported in the absence of structural heart disease. Extrinsic causes of sinus node dysfunction include autonomic imbalance and medications. Heavily conditioned athletes, and even normal preadolescent children (410 years old), may have bradycardia and sinus pauses of greater than 2 s due to prominent vagal influence. Recently, sleep apnea has been related to sinus node dysfunction. Many anti-arrhythmia medications can further impair the sinus node function particularly for patients with preexisting abnormalities. Neuromuscular disorders, such as Kearns Sayre (ophthalmoplegia, pigmentary degeneration of the retina, and cardiomyopathy), Friedreichs Ataxia and myotonic dystrophy may have a predilection for the conduction system and sinus node in particular. Immunologic basis for sinus node dysfunction have been seen in patients with anti-sinus node (ASN) antibodies as well as in donor hearts after orthotopic heart transplantation. Most commonly anti-Ro/SS-A or anti-LA/SS-B antibodies are well established in the mechanism of congenital AV block in infants of mothers with Sjgrens, lupus, or other undifferentiated autoimmune syndrome, but there also have been rare reports of sinus node dysfunction. While comprehensive this list may not include every cause of sick sinus syndrome.

• #21 Sinus Node Dysfunction: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/158064-overview

  The sinoatrial (SA) node is innervated by the parasympathetic and the sympathetic nervous systems; the balance between these systems controls the pacemaker rate. Parasympathetic input via the vagus nerves decreases the SA nodal pacemaker and is the dominant input at rest, whereas sympathetic nerve input, as well as the adrenal medullary release of catecholamines, increases the sinus rate during exercise and stress. […] Sinus node dysfunction (SND) is often secondary to senescence of the SA node and surrounding atrial myocardium. Medications may also contribute to, and can often unmask, subclinical SA dysfunction. […] SND occurs as a result of disorders in automaticity, conduction, or both. SN fibrosis is the most common cause of SND. […] Sinus node dysfunction (SND) involves abnormalities in SN impulse formation and propagation, which are often accompanied by similar abnormalities in the atrium and in the conduction system of the heart. Together, these abnormalities may result in inappropriately slow ventricular rates and long pauses at rest or during various stresses.

• #22 Biology of the Sinus Node and its Disease | AER Journal

  https://www.aerjournal.com/articles/biology-sinus-node-and-its-disease?language_content_entity=en

  The sinoatrial node (SAN) is the normal pacemaker of the heart and SAN dysfunction (SND) is common, but until recently the pathophysiology was incompletely understood. […] It is now evident that changes in the electrophysiology of the SAN, known as electrical remodelling, is an important process that has been demonstrated in SND associated with heart failure, ageing, diabetes, atrial fibrillation and endurance exercise. […] The pathophysiology of idiopathic SND is still not clearly understood. Historically it is attributed to fibrosis and cell senescence and this is often still quoted today. […] However, contemporary evidence suggests that electrical remodelling of molecular pacemaking mechanisms such as membrane ion channels and intracellular Ca2+ cycling are important factors in SND.

• #23 Sick sinus syndrome: MedlinePlus GeneticsLock

  https://medlineplus.gov/genetics/condition/sick-sinus-syndrome/

  Genetic changes are an uncommon cause of sick sinus syndrome. Mutations in two genes, SCN5A and HCN4, have been found to cause the condition in a small number of families. These genes provide instructions for making proteins called ion channels that transport positively charged atoms (ions) into cardiac cells, including cells that make up the SA node. The flow of these ions is essential for creating the electrical impulses that start each heartbeat and coordinate contraction of the cardiac muscle. Mutations in these genes reduce the flow of ions, which alters the SA node’s ability to create and spread electrical signals. These changes lead to abnormal heartbeats and the other symptoms of sick sinus syndrome. […] A particular variation in another gene, MYH6, appears to increase the risk of developing sick sinus syndrome. The protein produced from the MYH6 gene forms part of a larger protein called myosin, which generates the mechanical force needed for cardiac muscle to contract. Researchers believe that the MYH6 gene variation changes the structure of myosin, which can affect cardiac muscle contraction and increase the likelihood of developing an abnormal heartbeat.

• #24 Biology of the Sinus Node and its Disease | AER Journal

  https://www.aerjournal.com/articles/biology-sinus-node-and-its-disease?language_content_entity=en

  Regardless of the underlying pathology, SND is characterised by increased cSNRT, conduction delay along the CT, a more unicentric and caudal shift to leading pacemaker activity within the SAN and areas of low voltage within the right atrium attributed to atrophy and scar formation. […] There is widespread electrical remodelling of the atria with ageing, and this has also been demonstrated in the SAN. This electrical remodelling is the result of changes in the expression of key ion channels that cause dysfunction of the normal pacemaker activity in the SAN. […] Ageing is therefore associated with both structural and molecular remodelling and the cause of SND in this population is likely to be complex and heterogeneous. […] SND is often associated with intermittent episodes of atrial tachyarrhythmias such as atrial fibrillation (AF) leading to the term tachy-brady syndrome.

• #25 Frontiers | Trends in research on sick sinus syndrome: A bibliometric analysis from 2000 to 2022

  https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.991503/full

  The pathogenesis of SSS is related to many risk factors. […] The function of the sinus node decreased with age, leading to an increase in the incidence of sinus node dysfunction and the number of pacemaker implantation in the elderly. […] Atrial fibrillation and SSS often coexist, and they induce and perpetuate each other. […] Heart failure was a major risk factors for secondary sinus node dysfunction, the mechanism of which may be related to gene mutation in HCN4, a Na + /K + hyperpolarization-activated cyclic nucleotide-gated (HCN) channels that was a molecular marker of functional sinus node cell activity and played a key role in the pacemaker potential. […] The pathogenesis of SSS is associated with obesity, hypertensive heart disease, and autonomic neuropathy.

• #26 Frontiers | Trends in research on sick sinus syndrome: A bibliometric analysis from 2000 to 2022

  https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.991503/full

  Sick sinus syndrome (SSS) is a refractory arrhythmia disease caused by the pathological changes of sinoatrial node and its adjacent tissues. […] Although SSS was closely associated with atrial fibrillation, the exact underlying pathogenesis remains unclear. […] In a human and animal models of atrial fibrillation, atrial fibrillation induced remodeling of the right and left atria (including the sinus node), leading to atrial fibrosis, impaired calcium channels, and abnormal gene expression in patients with SSS, which exacerbates sinus node dysfunction and the progression of atrial fibrillation. […] Other studies suggested that aging and myocardial fibrosis may be a common pathogenesis of SSS and atrial fibrillation, but the research could not account for all cases of SSS and more in-depth pathogenesis needs further research.

• #27 Sick Sinus Syndrome Can Be Associated with Postural Tachycardia Syndrome and Inappropriate Sinus Tachycardia Syndrome

  https://www.innovationsincrm.com/cardiac-rhythm-management/articles-2021/may/1759-sick-sinus-syndrome

  As a known phenomenon, crossover between sinus node dysfunction and common atrial tachyarrhythmiasmost notably, atrial fibrillation and atrial flutterin older individuals has previously been seen. […] The exact pathological mechanisms behind these arrhythmias as well as the observation of concurrent nodal dysfunction are poorly understood. […] Clear mechanisms have yet to be elucidated but include impaired vascular innervation, elevated NE concentrations, – and -receptor sensitivity, and baroreceptor dysfunction. […] Similar mechanisms behind POTS and IST have been proposed, including intrinsically high sinus node automaticity rates due to ion channel dysfunction and alterations in autonomic nervous system tone together with decreased cardiovagal tone. […] In particular, abnormal autonomic modulation with elevated sympathetic and diminished parasympathetic tone has been shown to be a component of both POTS and IST.

• #28 Mitochondrial dysfunction is a key link involved in the pathogenesis of sick sinus syndrome: a review

  https://ouci.dntb.gov.ua/en/works/4vQzboM7/

  Sick sinus syndrome (SSS) is a grave medical condition that can precipitate sudden death. The pathogenesis of SSS remains incompletely understood. Existing research postulates that the fundamental mechanism involves increased fibrosis of the sinoatrial node and its surrounding tissues, as well as disturbances in the coupled-clock system, comprising the membrane clock and the Ca2+ clock. Mitochondrial dysfunction exacerbates regional tissue fibrosis and disrupts the functioning of both the membrane and calcium clocks. This plays a crucial role in the underlying pathophysiology of SSS, including mitochondrial energy metabolism disorders, mitochondrial oxidative stress damage, calcium overload, and mitochondrial quality control disorders. Elucidating the mitochondrial mechanisms involved in the pathophysiology of SSS and further investigating the disease’s mechanisms is of great significance.

• #29 Sinus Node Dysfunction: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/158064-overview

  Abnormal automaticity, or sinus arrest, refers to a failure of sinus impulse generation. Abnormal conduction, or SA delay or block, is a failure of impulse transmission. In such cases, the sinus impulse is generated normally, but it is abnormally conducted to the neighboring atrial tissue. Both abnormal automaticity and abnormal conduction may result from one of several different mechanisms, including fibrosis, atherosclerosis, and inflammatory or infiltrative myocardial processes. […] The most common cause of SND/sick sinus syndrome (SSS) is the replacement of sinus node (SN) tissue by fibrous tissue, which may be accompanied by degeneration and fibrosis of other parts of the conduction system as well, including the atrioventricular (AV) node. […] Local cardiac pathology, systemic diseases that involve the heart, and medications or toxins can all be responsible for abnormal SA node function and may result in SND.

• #30 Sinus Node Dysfunction: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/158064-overview

  Abnormal automaticity, or sinus arrest, refers to a failure of sinus impulse generation. Abnormal conduction, or SA delay or block, is a failure of impulse transmission. In such cases, the sinus impulse is generated normally, but it is abnormally conducted to the neighboring atrial tissue. Both abnormal automaticity and abnormal conduction may result from one of several different mechanisms, including fibrosis, atherosclerosis, and inflammatory or infiltrative myocardial processes. […] The most common cause of SND/sick sinus syndrome (SSS) is the replacement of sinus node (SN) tissue by fibrous tissue, which may be accompanied by degeneration and fibrosis of other parts of the conduction system as well, including the atrioventricular (AV) node. […] Local cardiac pathology, systemic diseases that involve the heart, and medications or toxins can all be responsible for abnormal SA node function and may result in SND.

• #31 Sick Sinus Syndrome: A Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0515/p691.html/1000

  Extrinsic factors that can mimic or exacerbate sick sinus syndrome include the use of certain pharmacologic agents, metabolic disturbances, and autonomic dysfunction. The pharmacologic agents that commonly cause dysfunction of the sinoatrial node are beta blockers, calcium channel blockers, digoxin, sympatholytic medications, antiarrhythmic medications, and lithium. […] Autonomic dysfunction can mimic or exacerbate sick sinus syndrome via neurally mediated bradycardia in vasovagal syncope, neurocardiogenic syncope, and carotid sinus hypersensitivity.

• #32 Sick Sinus Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29012

  Several external causes that can affect the pacing function of the SA node. These can occur in conditions where there is abnormally increased vagal tone such as carotid sinus hypersensitivity, vasovagal syncope, and autonomic dysfunction. Furthermore, metabolic derangements such as hypothyroidism, hyperkalemia, hypokalemia, hypocalcemia, hypoxia, and hypothermia can lead to depression of the pacing function of the SA node. […] The sinoatrial (SA) node is composed of a collection of atrial myocytes that are specialized into two different functional cells. Pacemaker P cells with intrinsic pacemaker function and transitional T cells which are responsible for propagating the impulse into the right atrium. Dysfunction of these cells leads to the several arrhythmias: […] Tachy-brady syndrome is identified by bradycardia alternating with paroxysmal supraventricular arrhythmias, most frequently atrial fibrillation (AF). This results from abnormal automaticity and conduction within the atrial tissue. It affects at least 50% of patients with SND.

• #33 Sick Sinus Syndrome: A Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0515/p691.html/1000

  Extrinsic factors that can mimic or exacerbate sick sinus syndrome include the use of certain pharmacologic agents, metabolic disturbances, and autonomic dysfunction. The pharmacologic agents that commonly cause dysfunction of the sinoatrial node are beta blockers, calcium channel blockers, digoxin, sympatholytic medications, antiarrhythmic medications, and lithium. […] Autonomic dysfunction can mimic or exacerbate sick sinus syndrome via neurally mediated bradycardia in vasovagal syncope, neurocardiogenic syncope, and carotid sinus hypersensitivity.

• #34 Sinus Node Dysfunction: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/158064-overview

  The sinoatrial (SA) node is innervated by the parasympathetic and the sympathetic nervous systems; the balance between these systems controls the pacemaker rate. Parasympathetic input via the vagus nerves decreases the SA nodal pacemaker and is the dominant input at rest, whereas sympathetic nerve input, as well as the adrenal medullary release of catecholamines, increases the sinus rate during exercise and stress. […] Sinus node dysfunction (SND) is often secondary to senescence of the SA node and surrounding atrial myocardium. Medications may also contribute to, and can often unmask, subclinical SA dysfunction. […] SND occurs as a result of disorders in automaticity, conduction, or both. SN fibrosis is the most common cause of SND. […] Sinus node dysfunction (SND) involves abnormalities in SN impulse formation and propagation, which are often accompanied by similar abnormalities in the atrium and in the conduction system of the heart. Together, these abnormalities may result in inappropriately slow ventricular rates and long pauses at rest or during various stresses.

• #35 Sick sinus syndrome: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000161.htm

  Sick sinus syndrome is a group of heart rhythm problems due to problems with the sinus node, such as: […] Sick sinus syndrome most often occurs in people older than age 50. It is often due to scar-like damage to electrical pathways in the heart muscle tissue. […] Tachycardias (rapid heart rhythms) that start in the upper chambers of the heart may be part of the syndrome. These include atrial fibrillation, atrial flutter, and atrial tachycardia. A period of fast heart rates is often followed by very slow heart rates. When there are periods of both slow and fast heart rates (rhythms) the condition often will be called tachy-brady syndrome. […] Some medicines can make abnormal heart rhythms worse, especially when doses are high. These include digitalis, calcium channel blockers, beta-blockers, and antiarrhythmics.

• #36 Sick sinus syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sick-sinus-syndrome/symptoms-causes/syc-20377554

  Sick sinus syndrome is a type of heart rhythm disorder. It affects the heart’s natural pacemaker (sinus node), which controls the heartbeat. Sick sinus syndrome causes slow heartbeats, pauses (long periods between heartbeats) or irregular heartbeats (arrhythmias). […] In sick sinus syndrome, the electrical signals are irregularly paced. The heartbeat can be too fast, too slow, interrupted by long pauses or an alternating combination of these rhythm issues. Sick sinus syndrome is relatively uncommon, but the risk of developing it increases with age. […] Causes of sick sinus node syndrome can include: Age-related wear and tear of heart tissues, Damage to the sinus node or scarring from heart surgery, Heart disease, Inflammatory diseases affecting the heart, Medications to treat high blood pressure, including calcium channel blockers and beta blockers, Medications to treat irregular heartbeats (arrhythmias), Some Alzheimer’s disease medications, Neuromuscular diseases, such as muscular dystrophy, Obstructive sleep apnea, Rare genetic changes.

• #37 Sick Sinus Syndrome: A Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0515/p691.html/1000

  Extrinsic factors that can mimic or exacerbate sick sinus syndrome include the use of certain pharmacologic agents, metabolic disturbances, and autonomic dysfunction. The pharmacologic agents that commonly cause dysfunction of the sinoatrial node are beta blockers, calcium channel blockers, digoxin, sympatholytic medications, antiarrhythmic medications, and lithium. […] Autonomic dysfunction can mimic or exacerbate sick sinus syndrome via neurally mediated bradycardia in vasovagal syncope, neurocardiogenic syncope, and carotid sinus hypersensitivity.

• #38 Sick Sinus Syndrome Can Be Associated with Postural Tachycardia Syndrome and Inappropriate Sinus Tachycardia Syndrome

  https://www.innovationsincrm.com/cardiac-rhythm-management/articles-2021/may/1759-sick-sinus-syndrome

  As a known phenomenon, crossover between sinus node dysfunction and common atrial tachyarrhythmiasmost notably, atrial fibrillation and atrial flutterin older individuals has previously been seen. […] The exact pathological mechanisms behind these arrhythmias as well as the observation of concurrent nodal dysfunction are poorly understood. […] Clear mechanisms have yet to be elucidated but include impaired vascular innervation, elevated NE concentrations, – and -receptor sensitivity, and baroreceptor dysfunction. […] Similar mechanisms behind POTS and IST have been proposed, including intrinsically high sinus node automaticity rates due to ion channel dysfunction and alterations in autonomic nervous system tone together with decreased cardiovagal tone. […] In particular, abnormal autonomic modulation with elevated sympathetic and diminished parasympathetic tone has been shown to be a component of both POTS and IST.

• #39 Sick Sinus Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29012

  Several external causes that can affect the pacing function of the SA node. These can occur in conditions where there is abnormally increased vagal tone such as carotid sinus hypersensitivity, vasovagal syncope, and autonomic dysfunction. Furthermore, metabolic derangements such as hypothyroidism, hyperkalemia, hypokalemia, hypocalcemia, hypoxia, and hypothermia can lead to depression of the pacing function of the SA node. […] The sinoatrial (SA) node is composed of a collection of atrial myocytes that are specialized into two different functional cells. Pacemaker P cells with intrinsic pacemaker function and transitional T cells which are responsible for propagating the impulse into the right atrium. Dysfunction of these cells leads to the several arrhythmias: […] Tachy-brady syndrome is identified by bradycardia alternating with paroxysmal supraventricular arrhythmias, most frequently atrial fibrillation (AF). This results from abnormal automaticity and conduction within the atrial tissue. It affects at least 50% of patients with SND.

• #40 Sick Sinus Syndrome: A Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0515/p691.html/1000

  Extrinsic factors that can mimic or exacerbate sick sinus syndrome include the use of certain pharmacologic agents, metabolic disturbances, and autonomic dysfunction. The pharmacologic agents that commonly cause dysfunction of the sinoatrial node are beta blockers, calcium channel blockers, digoxin, sympatholytic medications, antiarrhythmic medications, and lithium. […] Autonomic dysfunction can mimic or exacerbate sick sinus syndrome via neurally mediated bradycardia in vasovagal syncope, neurocardiogenic syncope, and carotid sinus hypersensitivity.

• #41

  https://journals.lww.com/md-journal/fulltext/2024/10250/the_effect_of_unhealthy_lifestyle_on_the.44.aspx

  Sick sinus syndrome (SSS), also known as sinoatrial node dysfunction, has been widely concerned by the medical community. The incidence rate of SSS is increasingly, which poses a great threat to public health. […] Through decades of repeated research in the medical field, great progress has been made in the pathogenesis of SSS and the interaction mechanism between SSS and other cardiovascular diseases. […] It also explains the mechanism of negative factors in the pathogenesis of SSS. These unhealthy lifestyle will lead to the occurrence of sinoatrial node disease and arrhythmia, and then induce SSS. […] The etiology and pathogenesis of SSS are complex. Iatrogenic factors such as ischemia and anoxia accompanied by various CVDs and improper drug treatment have been identified as the main risk of increasing the prevalence of SSS.

• #42

  https://journals.lww.com/md-journal/fulltext/2024/10250/the_effect_of_unhealthy_lifestyle_on_the.44.aspx

  The main pathogenesis is that the excessive secretion of thyroid hormone changes the regulation of ion transporter and the action potential produced in pacemaker cells, leading to the formation of abnormal impulses in sinoatrial node. This may be the main pathological mechanism of SSS caused by mental and social stress. […] The pathogenesis of SSS disease caused by excessive drinking may be achieved by the way that the metabolic products of ethanol accelerate the heart rate. […] The excessive release of catecholamine will not only lead to the long-term acceleration of heart rate, but also lead to the increase of calcium influx and intracellular calcium concentration in cardiomyocytes. […] The joint participation of nicotine, carbon monoxide, and oxidative stress will lead to the development of sinoatrial node syndrome or the aggravation of arrhythmia symptoms.

• #43

  https://journals.lww.com/md-journal/fulltext/2024/10250/the_effect_of_unhealthy_lifestyle_on_the.44.aspx

  The main pathogenesis is that the excessive secretion of thyroid hormone changes the regulation of ion transporter and the action potential produced in pacemaker cells, leading to the formation of abnormal impulses in sinoatrial node. This may be the main pathological mechanism of SSS caused by mental and social stress. […] The pathogenesis of SSS disease caused by excessive drinking may be achieved by the way that the metabolic products of ethanol accelerate the heart rate. […] The excessive release of catecholamine will not only lead to the long-term acceleration of heart rate, but also lead to the increase of calcium influx and intracellular calcium concentration in cardiomyocytes. […] The joint participation of nicotine, carbon monoxide, and oxidative stress will lead to the development of sinoatrial node syndrome or the aggravation of arrhythmia symptoms.

• #44

  https://journals.lww.com/md-journal/fulltext/2024/10250/the_effect_of_unhealthy_lifestyle_on_the.44.aspx

  The main pathogenesis is that the excessive secretion of thyroid hormone changes the regulation of ion transporter and the action potential produced in pacemaker cells, leading to the formation of abnormal impulses in sinoatrial node. This may be the main pathological mechanism of SSS caused by mental and social stress. […] The pathogenesis of SSS disease caused by excessive drinking may be achieved by the way that the metabolic products of ethanol accelerate the heart rate. […] The excessive release of catecholamine will not only lead to the long-term acceleration of heart rate, but also lead to the increase of calcium influx and intracellular calcium concentration in cardiomyocytes. […] The joint participation of nicotine, carbon monoxide, and oxidative stress will lead to the development of sinoatrial node syndrome or the aggravation of arrhythmia symptoms.

• #45

  https://journals.lww.com/md-journal/fulltext/2024/10250/the_effect_of_unhealthy_lifestyle_on_the.44.aspx

  The abnormal expression of calcium channel Cav1.2 will further reduce the self-regulation of sinoatrial node cells and lead to sinoatrial node dysfunction. […] Therefore, this study confirmed that the incidence of sinoatrial syndrome is closely related to high-fat diet, for example, obesity and dyslipidemia caused by high-fat diet are important risk factors of sinoatrial syndrome. […] The pathogenesis of arrhythmia and sinoatrial node function caused by sedentary and lack of exercise may be due to the over secretion or under secretion of various neurohormones caused by hypertension, which affects the electrophysiological balance of sinoatrial node cells. […] The increase of BP caused by lack of exercise and sedentary will also destroy normal myocardial fiber tissue and slow down conduction, generate electrical heterogeneity, and lead to abnormal electrical activity, which is also the potential mechanism of SSS.

• #46

  https://journals.lww.com/md-journal/fulltext/2024/10250/the_effect_of_unhealthy_lifestyle_on_the.44.aspx

  The abnormal expression of calcium channel Cav1.2 will further reduce the self-regulation of sinoatrial node cells and lead to sinoatrial node dysfunction. […] Therefore, this study confirmed that the incidence of sinoatrial syndrome is closely related to high-fat diet, for example, obesity and dyslipidemia caused by high-fat diet are important risk factors of sinoatrial syndrome. […] The pathogenesis of arrhythmia and sinoatrial node function caused by sedentary and lack of exercise may be due to the over secretion or under secretion of various neurohormones caused by hypertension, which affects the electrophysiological balance of sinoatrial node cells. […] The increase of BP caused by lack of exercise and sedentary will also destroy normal myocardial fiber tissue and slow down conduction, generate electrical heterogeneity, and lead to abnormal electrical activity, which is also the potential mechanism of SSS.

• #47

  https://journals.lww.com/md-journal/fulltext/2024/10250/the_effect_of_unhealthy_lifestyle_on_the.44.aspx

  The long-term increase of BP will indirectly lead to the imbalance of calcium concentration inside and outside the cardiac myocytes and sinoatrial node cells, and eventually lead to the autonomic disorder of sinoatrial node cells and destroy the normal physiological function of sinoatrial node. […] The increase of BP caused by sleep deprivation and poor sleep quality may also be involved in the mechanism of SSS. […] Although sleep deprivation and poor sleep quality, and how sleep apnea syndrome (OSAHS) is involved in the pathogenesis of SSS have not been elucidated. However, patients who lack of sleep time should adjust their work and rest time in time to avoid heart overload.

• #48 Sick sinus syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/sick-sinus-syndrome/symptoms-causes/syc-20377554

  Features of sick sinus syndrome include: Sinus bradycardia. The sinus node produces a slow heartbeat. Sinus arrest. Signals from the sinus node pause, causing skipped beats. Sinoatrial exit block. Signals to the upper heart chambers are slowed or blocked, causing pauses or skipped beats. Chronotropic incompetence. The heart rate is within regular range at rest but doesn’t increase as much as it should with physical activity. Tachycardia-bradycardia syndrome. The heart rate alternates between unusually slow and fast rhythms, often with a long pause between heartbeats.

• #49 Sick Sinus Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29012

  Several external causes that can affect the pacing function of the SA node. These can occur in conditions where there is abnormally increased vagal tone such as carotid sinus hypersensitivity, vasovagal syncope, and autonomic dysfunction. Furthermore, metabolic derangements such as hypothyroidism, hyperkalemia, hypokalemia, hypocalcemia, hypoxia, and hypothermia can lead to depression of the pacing function of the SA node. […] The sinoatrial (SA) node is composed of a collection of atrial myocytes that are specialized into two different functional cells. Pacemaker P cells with intrinsic pacemaker function and transitional T cells which are responsible for propagating the impulse into the right atrium. Dysfunction of these cells leads to the several arrhythmias: […] Tachy-brady syndrome is identified by bradycardia alternating with paroxysmal supraventricular arrhythmias, most frequently atrial fibrillation (AF). This results from abnormal automaticity and conduction within the atrial tissue. It affects at least 50% of patients with SND.

• #50 Sick Sinus Syndrome | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/29012

  Several external causes that can affect the pacing function of the SA node. These can occur in conditions where there is abnormally increased vagal tone such as carotid sinus hypersensitivity, vasovagal syncope, and autonomic dysfunction. Furthermore, metabolic derangements such as hypothyroidism, hyperkalemia, hypokalemia, hypocalcemia, hypoxia, and hypothermia can lead to depression of the pacing function of the SA node. […] The sinoatrial (SA) node is composed of a collection of atrial myocytes that are specialized into two different functional cells. Pacemaker P cells with intrinsic pacemaker function and transitional T cells which are responsible for propagating the impulse into the right atrium. Dysfunction of these cells leads to the several arrhythmias: […] Tachy-brady syndrome is identified by bradycardia alternating with paroxysmal supraventricular arrhythmias, most frequently atrial fibrillation (AF). This results from abnormal automaticity and conduction within the atrial tissue. It affects at least 50% of patients with SND.

• #51 Sick Sinus Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK470599/

  Recent studies have identified several mutations in the ion channels explaining familial and congenital forms of sick sinus syndrome. […] Heart failure and atrial tachyarrhythmias have been shown to induce cellular remodeling of the sinus node in animal models. […] Several external causes that can affect the pacing function of the SA node. […] The sinoatrial (SA) node is composed of a collection of atrial myocytes that are specialized into two different functional cells. […] Dysfunction of these cells leads to the several arrhythmias: […] The natural history of sinus node dysfunction is usually a slow progression over decades. […] Sinus pauses or severe bradycardia results in central nervous system (CNS) underperfusion which manifests in paroxysmal presyncope or syncope. […] The management of sinus node dysfunction includes identifying and correcting reversible factors, as an initial step.

• #52 Sick Sinus Syndrome – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/specific-cardiac-arrhythmias/sick-sinus-syndrome

  Sick sinus syndrome refers to sinus node dysfunction causing slow, physiologically inappropriate, heart rates. […] In the brady-tachy variant of the sick sinus syndrome, sinus node dysfunction is associated with atrial tachyarrhythmias, most commonly atrial fibrillation. […] The most common cause of intrinsic sinus node dysfunction in the sick sinus syndrome is idiopathic SA node fibrosis, which may be accompanied by degeneration of lower elements of the conducting system, manifested as concomitant atrioventricular (AV block and/or bundle branch block). […] Other causes of sick sinus syndrome include sleep apnea, medications, excessive vagal tone, and many ischemic, inflammatory, and infiltrative disorders. […] Sinus node dysfunction in the sick sinus syndrome tends worsen over time. The prognosis is otherwise mixed; mortality is about 4%/year, primarily resulting from an underlying structural heart disorder. Each year, about 5% of patients develop atrial fibrillation with its risks of heart failure and stroke.

• #53 Sick Sinus Syndrome: Symptoms & Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/sick-sinus-syndrome

  Inflammatory diseases such as pericarditis or endocarditis can cause inflammation of the heart tissue, leading to sick sinus syndrome. […] Specific medications can cause or exacerbate sick sinus syndrome, including beta-blockers, calcium channel blockers, and drugs used to treat arrhythmias. […] If you have abnormal potassium, calcium, or magnesium levels in your blood, these imbalances can raise the risk of developing sick sinus syndrome. […] If you have bradycardia, sinus pauses, or other heart rhythm abnormalities, you may receive a permanent pacemaker. This implant continuously monitors your heart and delivers electrical impulses to keep your heart rate steady. […] This disorder can lead to various complications, especially when left untreated. Potential problems include: Bradycardia-tachycardia syndrome: This disorder occurs when the heart fluctuates between beating too quickly and too slowly. […] Although sick sinus syndrome doesnt usually cause heart failure, the arrhythmias associated with the condition could contribute to serious heart issues if left untreated. By effectively managing the symptoms of sick sinus syndrome, you can minimize your risk of heart-related complications.

• #54 Sick Sinus Syndrome – Cardiovascular Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/cardiovascular-disorders/specific-cardiac-arrhythmias/sick-sinus-syndrome

  Sick sinus syndrome refers to sinus node dysfunction causing slow, physiologically inappropriate, heart rates. […] In the brady-tachy variant of the sick sinus syndrome, sinus node dysfunction is associated with atrial tachyarrhythmias, most commonly atrial fibrillation. […] The most common cause of intrinsic sinus node dysfunction in the sick sinus syndrome is idiopathic SA node fibrosis, which may be accompanied by degeneration of lower elements of the conducting system, manifested as concomitant atrioventricular (AV block and/or bundle branch block). […] Other causes of sick sinus syndrome include sleep apnea, medications, excessive vagal tone, and many ischemic, inflammatory, and infiltrative disorders. […] Sinus node dysfunction in the sick sinus syndrome tends worsen over time. The prognosis is otherwise mixed; mortality is about 4%/year, primarily resulting from an underlying structural heart disorder. Each year, about 5% of patients develop atrial fibrillation with its risks of heart failure and stroke.

• #55 Sick Sinus Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/sites/books/NBK470599/

  After treating reversible causes, the treatment of sinus node dysfunction can include the placement of a permanent pacemaker. […] A permanent pacemaker is indicated in symptomatic patients who have documented bradycardia responsible for their symptoms or in those who have demonstrated chronotropic incompetence. […] Sinus node dysfunction follows a benign course and the risk of sudden cardiac death is low, as sinus node dysfunction has not been shown to impact survival whether treated with a pacemaker or not.

• #56 Sick Sinus Syndrome: Symptoms, Causes and Treatment.

  https://my.clevelandclinic.org/health/diseases/21789-sick-sinus-syndrome

  Sick sinus syndrome usually keeps getting worse slowly over many years, but some people never end up with other health issues connected to sick sinus syndrome. A pacemaker can help your symptoms and give you a better quality of life, but it may not extend your life expectancy. […] Sick sinus syndrome is a long-term problem that slowly gets worse over a number of years.

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