eMedicine Specialties > Emergency Medicine > Cardiovascular

Sinus Bradycardia: Follow-up

Author: Mark W Livingston, MD, Consulting Staff, Department of Emergency Medicine, Yakima Valley Memorial Hospital
Coauthor(s): David T Overton, MD, Professor, Chair, Program Director, Department of Emergency Medicine, Michigan State University, Kalamazoo Center for Medical Studies
Contributor Information and Disclosures

Updated: Aug 4, 2009

Follow-up

Further Inpatient Care

  • Once the patient's condition is stabilized, inpatient care must be tailored to the inciting cause of the dysrhythmia.

Further Outpatient Care

  • Outpatient follow-up care is dependent on the underlying cause of the bradycardia.
  • Most patients should be able to follow up with their primary care provider or obtain a referral for a follow-up visit.
  • Some patients may require specialized referral to a cardiologist.
  • Regular follow-up care is necessary for patients in whom a permanent pacemaker is placed.

Complications

  • Patients with sick sinus syndrome may convert to atrial fibrillation, a rhythm that is amenable to medical therapy and may eliminate the need for pacemaker placement.

Miscellaneous

Medicolegal Pitfalls

  • Failure to arrange prompt follow-up care in patients with symptomatic sinus bradycardia exposes the emergency medicine practitioner to considerable medicolegal risk.
 


More on Sinus Bradycardia

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

  1. [Guideline] Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol. May 27 2008;51(21):e1-62. [Medline]. [Full Text].

  2. Grantham HJ. Emergency management of acute cardiac arrhythmias. Aust Fam Physician. Jul 2007;36(7):492-7. [Medline]. [Full Text].

  3. Bharati S, Nordenberg A, Bauernfiend R, Varghese JP, Carvalho AG, Rosen K, et al. The anatomic substrate for the sick sinus syndrome in adolescence. Am J Cardiol. Jul 1980;46(1):163-72. [Medline].

  4. Chokshi DS, Mascarenhas E, Samet P, Center S. Treatment of sinoatrial rhythm disturbances with permanent cardiac pacing. Am J Cardiol. Aug 1973;32(2):215-20. [Medline].

  5. Davies MJ, Pomerance A. Quantitative study of ageing changes in the human sinoatrial node and internodal tracts. Br Heart J. Feb 1972;34(2):150-2. [Medline].

  6. Ferrer MI. The sick sinus syndrome in atrial disease. JAMA. Oct 14 1968;206(3):645-6. [Medline].

  7. Gann D, Tolentino A, Samet P. Electrophysiologic evaluation of elderly patients with sinus bradycardia: a long-term follow-up study. Ann Intern Med. Jan 1979;90(1):24-9. [Medline].

  8. Krahn AD, Klein GJ, Norris C, Yee R. The etiology of syncope in patients with negative tilt table and electrophysiological testing. Circulation. Oct 1 1995;92(7):1819-24. [Medline].

  9. Kulbertus HE, De Leval-Rutten F, Demoulin JC. Sino-atrial disease: a report on 13 cases. J Electrocardiol. 1973;6(4):303-12. [Medline].

  10. Maisch B, Lotze U, Schneider J, Kochsiek K. Antibodies to human sinus node in sick sinus syndrome. Pacing Clin Electrophysiol. Nov 1986;9(6 Pt 2):1101-9. [Medline].

  11. Margolis JR, Strauss HC, Miller HC, Gilbert M, Wallace AG. Digitalis and the sick sinus syndrome. Clinical and electrophysiologic documentation of severe toxic effect on sinus node function. Circulation. Jul 1975;52(1):162-9. [Medline].

  12. Mills TA, Kawji MM, Cataldo VD, Pappas ND, O'Meallie LP, Breaux DM, et al. Profound sinus bradycardia due to diltiazem, verapamil, and/or beta-adrenergic blocking drugs. J La State Med Soc. Nov-Dec 2004;156(6):327-31. [Medline].

  13. Pollock G, Brady WJ Jr, Hargarten S, DeSilvey D, Carner CT. Hypoglycemia manifested by sinus bradycardia: a report of three cases. Acad Emerg Med. Jul 1996;3(7):700-7. [Medline].

  14. Rosenqvist M, Brandt J, Schüller H. Atrial versus ventricular pacing in sinus node disease: a treatment comparison study. Am Heart J. Feb 1986;111(2):292-7. [Medline].

  15. Sasaki Y, Shimotori M, Akahane K, Yonekura H, Hirano K, Endoh R, et al. Long-term follow-up of patients with sick sinus syndrome: a comparison of clinical aspects among unpaced, ventricular inhibited paced, and physiologically paced groups. Pacing Clin Electrophysiol. Nov 1988;11(11 Pt 1):1575-83. [Medline].

  16. Touboul P, Atallah G, Gressard A, Kirkorian G. Effects of amiodarone on sinus node in man. Br Heart J. Nov 1979;42(5):573-8. [Medline].

  17. Watt AH. Sick sinus syndrome: an adenosine-mediated disease. Lancet. Apr 6 1985;1(8432):786-8. [Medline].

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Further Reading

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Keywords

sinus bradycardia, vagal tone, bradycardia, inferior wall myocardial infarction, electrolyte disorders, tachycardia, sinus arrest, first-degree block, second-degree block, third-degree block, complete SA block, hypothermia, hypoglycemia, sleep apnea, diphtheria, rheumatic fever, viral myocarditis, digitalis glycosides, beta-blockers, calcium channel-blocking agents, class I antiarrhythmic agents, amiodarone, increased vagal tone, infection, hypothyroidism, increased intracranial pressure, sick sinus syndrome, cerebral hypoperfusion, sinoatrial block, SA block, carotid hypersensitivity, syncope, dizziness, shortness of breath, lightheadedness, chest pain, myocardial infarction, congestive heart failure, valvular failure

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Contributor Information and Disclosures

Author

Mark W Livingston, MD, Consulting Staff, Department of Emergency Medicine, Yakima Valley Memorial Hospital
Disclosure: Nothing to disclose.

Coauthor(s)

David T Overton, MD, Professor, Chair, Program Director, Department of Emergency Medicine, Michigan State University, Kalamazoo Center for Medical Studies
David T Overton, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Physician Executives, and American College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

Daniel J Dire, MD, FACEP, FAAP, FAAEM, Clinical Professor, Department of Emergency Medicine, University of Texas-Houston; Clinical Professor, Department of Pediatrics, University of Texas Health Sciences Center, San Antonio, Texas
Daniel J Dire, MD, FACEP, FAAP, FAAEM is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, and Association of Military Surgeons of the US
Disclosure: Talecris Biotherapeutics Honoraria Speaking and teaching

Pharmacy Editor

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

Managing Editor

Gary Setnik, MD, Chair, Department of Emergency Medicine, Mount Auburn Hospital; Assistant Professor, Division of Emergency Medicine, Harvard Medical School
Gary Setnik, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: SironaHealth Salary Management position; South Middlesex EMS Consortium Salary Management position

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD, Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital
David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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