Treatment of Sick Sinus Syndrome: Pacing Strategy for Symptomatic SND
Clinical scenario
Sick sinus syndrome (SND) encompasses a spectrum of sinus node dysfunction presenting with symptomatic bradyarrhythmias. When symptoms can be clearly attributed to sinus node dysfunction, a structured, evidence-based approach to rhythm management is indicated.
Treatment approach — partial overview
Permanent cardiac pacing is the cornerstone of treatment for symptomatic SND. The selection of the appropriate pacing modality and programming strategy depends on individual patient factors — full details including mode choice, programming priorities, and alternative lead configurations are covered in the structured protocol.
Full regimen, mode selection algorithm, and programming guidance available via the protocol →
References
- Pacing is indicated in SND when symptoms can clearly be attributed to bradyarrhythmias.
- In view of these data, DDD(R) is the pacing mode of first choice in SND.
- In patients with SND and a DDD pacemaker, minimization of unnecessary ventricular pacing through programming is recommended.
- Unnecessary RV pacing should be systematically avoided in patients with SND, because it may cause AF and deterioration of HF, particularly if systolic function is impaired or borderline.
- Reasons to avoid two leads include young age and limited venous access.
DOI: 10.1093/eurheartj/ehab364
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