Sinus Node Dysfunction Medication

Updated: Nov 30, 2018
  • Author: Bharat K Kantharia, MD, FRCP, FAHA, FACC, FESC, FHRS; Chief Editor: Mikhael F El-Chami, MD  more...
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Medication

Medication Summary

Currently, no medications are routinely used to treat symptomatic sinus node dysfunction (SND). Virtually most medications are ineffective over the long term, and many demonstrate lack of efficacy from tachyphylaxis. Nonetheless, acute treatment with the anticholinergic agent atropine and/or the adrenergic agonist isoproterenol may be warranted. Oral analogues of these drugs (eg, propantheline and orciprenaline [metaproterenol], respectively) are not effective on a long-term basis.

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Anticholinergic Agents

Class Summary

Atropine, by vagolytic effect, increases the heart rate. Although it may also be used for the initial treatment of chronic arrhythmias, cardiac pacing is preferred for long-term control.

Atropine

Atropine increases the heart rate through vagolytic effects, causing an increase in cardiac output.

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Beta1/Beta2 Adrenergic Agonists

Class Summary

When given systemically, isoproterenol stimulates beta receptors in the heart, which produces positive inotropic and chronotropic effects. This results in increased cardiac output.

Isoproterenol (Isuprel)

Isoproterenol has sympathomimetic effects; specifically, beta1- and beta2-adrenergic receptor agonist activity.

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Cardiovascular, Other

Class Summary

It may be necessary to use antiarrhythmic agents for concomitant tachyarrhythmia.

Quinidine

Quinidine maintains normal heart rhythm following cardioversion of atrial fibrillation or flutter. It depresses myocardial excitability and conduction velocity. Control the ventricular rate and CHF (if present) with digoxin or calcium channel blockers before the administration of quinidine.

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