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Treatments and drugs
By Mayo Clinic staffTreatment for sick sinus syndrome focuses on eliminating or reducing unpleasant symptoms. If you aren't bothered by symptoms, you may only need regular checkups to monitor your condition. For people who are bothered by symptoms, the treatment of choice is usually an implanted electronic pacemaker.
Medication changes
Your doctor may start by looking at your current medications to see if any of them could be interfering with the function of your sinus node. Medications used to treat high blood pressure or heart disease — such as beta blockers or calcium channel blockers — can worsen abnormal heart rhythms. In some cases, adjusting these medications can relieve symptoms.
Pacing the heart
Most people with sick sinus syndrome eventually need a permanent artificial pacemaker to maintain a regular heartbeat. This small, battery-powered electronic device is implanted under the skin near your collarbone during a minor surgical procedure. The pacemaker is programmed to stimulate or "pace" your heart as needed to keep it beating normally.
The type of pacemaker you need depends on the type of irregular heart rhythm you're experiencing. Some rhythms can be treated with a single-chamber pacemaker, which uses only one wire (lead) to pace one chamber of the heart — in this case, the atrium. However, most people with sick sinus syndrome benefit from dual-chamber pacemakers, in which one lead paces the atrium and one lead paces the ventricle.
You'll be able to resume normal or near-normal activities after you recover from pacemaker implantation surgery. The risk of complications, such as swelling or infection in the area where the pacemaker was implanted, is less than 5 percent.
Additional treatments for fast heart rate
If you have rapid heart rate as part of your sick sinus syndrome, you may need additional treatments to control these rhythms:
- Medications. If you have a pacemaker and your heart rate is still too fast, your doctor may prescribe anti-arrhythmia medications to prevent fast rhythms. If you have atrial fibrillation or other abnormal heart rhythms that increase your risk of stroke, you may need a blood-thinning medicine, such as warfarin (Coumadin).
- AV node ablation. This procedure can also control fast heart rhythms in people with pacemakers. It involves applying radiofrequency energy through a long, thin tube (catheter) to destroy (ablate) the tissue around the atrioventricular (AV) node between the atria and the ventricles. This stops fast heart rates from reaching the ventricles and causing problems.
- Radiofrequency ablation of atrial fibrillation. This procedure is similar to AV node ablation. However, in this case, ablation targets the tissue in the atria that triggers atrial fibrillation. This actually eliminates atrial fibrillation itself, rather than just preventing it from reaching the ventricles.
- Sick sinus syndrome. Heart Rhythm Society. http://www.hrspatients.org/patients/heart_disorders/sick_sinus/default.asp. Accessed March 19, 2009.
- Ferri F. Sick sinus syndrome. In: Ferri FF. Ferri's Clinical Advisor 2009. St. Louis, Mo.: Mosby; 2008. http://www.mdconsult.com/das/book/body/127077711-3/819048192/1701/546.html#4-u1.0-B978-0-323-04134-8..50022-7--cesec438_11555. Accessed March 19, 2009.
- Bradyarrhythmias. In: Libby P, et al, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/book/player/book.do?method=display&type=aboutPage&decorator=header&eid=4-u1.0-B978-1-4160-4106-1..X5001-8--TOP&isbn=978-1-4160-4106-1&uniq=127077711#lpState=open&lpTab=contentsTab&content=4-u1.0-B978-1-4160-4106-1..50038-8--cesec163%3Bfrom%3Dindex%3Btype%3DbookPage%3Bisbn%3D978-1-4160-4106-1. Accessed March 12, 2009.
- Arnsdorf MF. Manifestations and causes of the sick sinus syndrome. http://www.uptodate.com/home/index.html. Accessed March 19, 2009.
- Dual-chamber pacemakers for symptomatic bradycardia due to sick sinus syndrome and/or atrioventricular block. Rockville, Md.: Agency for Healthcare Research and Quality. http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=8124&nbr=4526. Accessed March 19, 2009.
- What is a pacemaker? National Heart Lung and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/pace/pace_all.html. Accessed March 19, 2009.
- Arnsdorf MF. Treatment of the sick sinus syndrome. http://www.uptodate.com/home/index.html. Accessed March 19, 2009.
