eMedicine Specialties > Cardiology > Arrhythmias

Sinus Node Dysfunction: Follow-up

Author: Yingbo Yang, MD, PhD, Clinical Assistant Professor of Cardiovascular Medicine, Division of Cardiology, Lawrence J Ellison Ambulatory Care Center, University of California, Davis, Medical Center
Coauthor(s): Yasir Batres, MD, Fellow, Division of Cardiology, University of California, Davis, Medical Center
Contributor Information and Disclosures

Updated: Aug 31, 2009

Follow-up

Further Inpatient Care

Admit patients for testing and pacemaker placement when indicated.

Further Outpatient Care

Asymptomatic patients with SND should be observed for symptoms.

In patients with a pacemaker, the following should be performed on routine pacemaker interrogations:

Transfer

Transfer patients for complicated dysarrhythmias and pacemaker implant.

Deterrence/Prevention

Treat heart diseases related to SND and extrinsic causes to delay and prevent SND.

Complications

  • Sudden cardiac death (rare)
  • Syncope
  • Fall
  • Thromboembolic events including stroke (especially in patients with tachy-brady syndrome)
  • Congestive heart failure
  • Arrhythmias

Prognosis

The incidence of sudden cardiac death in patients with SND is very low.5 The mortality in patients with SND is primarily determined by underlying heart diseases. The patients with tachy-brady syndrome have a worse prognosis than patients with isolated SND. Pacemaker therapy does not appear to affect survival in patients with SND5,6,7 and is, therefore, used primarily for alleviation of symptoms.

Patient Education

  • Educate patients to recognize symptoms of SND.
  • Educate patients on pacemakers.
  • Family members should learn cardiopulmonary resuscitation (CPR).

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose symptomatic SND
  • Inappropriate pacemaker therapy
 
Acknowledgments

We thank Dr. Adrian W Messerli, MD and professor Alan D Forker, MD for their important contributions to this article as the authors of its previous edition. 



More on Sinus Node Dysfunction

Overview: Sinus Node Dysfunction
Differential Diagnoses & Workup: Sinus Node Dysfunction
Treatment & Medication: Sinus Node Dysfunction
Follow-up: Sinus Node Dysfunction
References
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References

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Further Reading

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Keywords

sick sinus syndrome, sinus node dysfunction, SND, sinoatrial disease, sinoatrial dysfunction, sluggish sinus syndrome, sinus nodal dysfunction, Valsalva maneuver, carotid sinus massage, idiopathic degenerative disease, coronary artery disease, autonomic hyperactivity, intrinsic sinus nodal dysfunction, infiltrative diseases, cardiomyopathy, hypertension, collagen vascular diseases, congenital heart disease, heart transplant, musculoskeletal disorders, myocarditis, pericarditis, beta-blockers, nondihydropyridine calcium channel blockers, cardiac glycosides, sympatholytic antihypertensives, membrane-active antiarrhythmics, autonomic dysfunction, vasovagal syncope, carotid sinus syndrome, extrinsic sinus nodal dysfunction, electrolyte imbalance, hypothyroidism, hyperthyroidism, hypothermia, sepsis

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Contributor Information and Disclosures

Author

Yingbo Yang, MD, PhD, Clinical Assistant Professor of Cardiovascular Medicine, Division of Cardiology, Lawrence J Ellison Ambulatory Care Center, University of California, Davis, Medical Center
Yingbo Yang, MD, PhD is a member of the following medical societies: American College of Cardiology and Heart Rhythm Society
Disclosure: Nothing to disclose.

Coauthor(s)

Yasir Batres, MD, Fellow, Division of Cardiology, University of California, Davis, Medical Center
Yasir Batres, MD is a member of the following medical societies: American College of Cardiology
Disclosure: Nothing to disclose.

Medical Editor

Justin D Pearlman, MD, PhD, ME, MA, Director of Advanced Cardiovascular Imaging, Professor of Medicine, Professor of Radiology, Adjunct Professor, Thayer Bioengineering and Computer Science, Dartmouth-Hitchcock Medical Center
Justin D Pearlman, MD, PhD, ME, MA is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Federation for Medical Research, International Society for Magnetic Resonance in Medicine, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Brian Olshansky, MD, Professor of Medicine, Department of Internal Medicine, University of Iowa College of Medicine
Brian Olshansky, MD is a member of the following medical societies: American Autonomic Society, American College of Cardiology, American College of Chest Physicians, American College of Physicians, American College of Sports Medicine, American Federation for Clinical Research, American Heart Association, Cardiac Electrophysiology Society, Heart Rhythm Society, and New York Academy of Sciences
Disclosure: Guidant/Boston Scientific Honoraria Speaking and teaching; Medtronic Honoraria Speaking and teaching; Guidant/Boston Scientific Consulting fee Consulting; Reliant Grant/research funds Other; Novartis Honoraria Speaking and teaching; Novartis Consulting fee Consulting

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Michael E Zevitz, MD, Assistant Professor of Medicine, Finch University of the Health Sciences, The Chicago Medical School; Consulting Staff, Private Practice
Michael E Zevitz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Medical Association, and Michigan State Medical Society
Disclosure: Nothing to disclose.

 
 
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