Sick sinus syndrome
ICD-10 I49.5 · ICD-11 BC80.20

Treatment of Sick Sinus Syndrome in Symptomatic Bradycardia-Tachycardia Form of Sinus Node Dysfunction

This protocol addresses management of symptomatic sick sinus syndrome presenting specifically as the bradycardia-tachycardia form — a pattern in which bradyarrhythmias occur in association with atrial tachyarrhythmias, most commonly atrial fibrillation.

Clinical scenario
Patients present with symptomatic sinus node dysfunction in its bradycardia-tachycardia variant: bradyarrhythmias associated with atrial tachyarrhythmias (mainly atrial fibrillation). This combination creates a specific therapeutic challenge, as both components require coordinated management.
Approach — partial overview
Management centres on correcting the bradyarrhythmia component to enable treatment of the associated tachyarrhythmia. Pacing-based intervention is the primary approach, with catheter ablation of the atrial tachyarrhythmia representing an alternative strategy in selected patients.
The complete regimen — including specific device programming, selection criteria, and the sequencing of interventions — is in the full structured protocol.
Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1093/eurheartj/ehab364

  1. Pacing is indicated in symptomatic patients with the bradycardiatachycardia form of SND in order to correct bradyarrhythmias and enable pharmacological treatment, unless ablation of the tachyarrhythmia is preferred.
  2. In patients with the bradycardiatachycardia variant of SND, programming of atrial ATP may be considered.
  3. AF ablation should be considered as a strategy to avoid pacemaker implantation in patients with AF-related bradycardia or symptomatic pre-automaticity pauses, after AF conversion, taking into account the clinical situation.
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