Management of Stokes-Adams Syndrome

Abstract

Stokes-Adams attacks are related to paroxysmal or chronic atrioventricular (AV) block (50-60%), sinoatrial (SA) block (30-40%) or paroxysmal tachycardia or fibrillation (0-5%). In between attacks most patients present with sinus rhythm, a large part with widened QRS complex. A minor proportion of patients present with chronic AV block. ECG is very rarely normal. Diagnosis is based on ECG recording during fainting. In patients with sinus rhythm and bundle-branch block or AV block, ECG monitoring should be performed in hospital, since Stokes-Adams syndrome in these patients is a potentially life-threatening disease. In sick sinus syndrome where the suspected arrthymia is not life-threatening, ambulatory ECG by Holter monitoring can be performed to establish the diagnosis. In cases where ECG monitoring leaves doubt, an electrophysiologic study including His bundle electrogra-phy and sinus node recovery time may support the diagnosis, although normal findings do not preclude the diagnosis. Pacemaker implantation should be performed in Stokes-Adams syndrome, as oral drug treatment is ineffective. The dual-chamber pacemaker presents the advantages of both physiological heart rate and AV synchrony, but has troublesome side effects. Most patients with tachycardia/bradycardia syndromes require supplementary anti-arrhythmic treatment, and in some patients additional long-term anticoagulation should be considered.

Clinical profiles of patients undergoing pacemaker implantation in India

“…[8][9][10][11][12][13][14][15][16] Hypertension (78.20%) was the most common associated co-morbidity and 23.07% patients were diabetic, consistent with previous studies. …”

Indications for and the diagnostic yield of 24-hour Holter monitoring: a prospective study at the Korle Bu Teaching Hospital

“…Arrhythmia causing seizures (Stokes-Adam attack) is rare. 33 Our current study found diagnostic yields (symptomsarrhythmia correlation) were 24.0% in symptomatic group and 3.0% in asymptomatic group and an overall diagnostic yield of 19.6%. This difference in the diagnostic yield in the two groups is supported by the findings of Luxon et al 34 in which haemodynamically significant arrhythmia were found to occur in 32% of cases with transient neurological symptoms compared to only 3% in controls.…”

A Rare Presentation of Sick Sinus Syndrome: Generalized Seizures

“…Sinus Sick Syndrome encompasses a range of SA node abnormalities. Our patient's likely diagnosis is due to his elderly age and variable manifestations on ECG: junctional bradycardia, asystole, AV block, and atrial tachycardia syndrome [3]. Additionally, this patient was taking Propanolol, which is also known to cause bradycardia.…”