The Sick Sinus Syndrome

Ferrer, M. Irené

doi:10.1161/01.cir.47.3.635

Cited by 298 publications

(52 citation statements)

References 19 publications

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“…1,2 In sinus arrest or sinus pause, the sinus node transiently ceases to generate electrical impulses. 3 The pause can last from a couple of seconds to several minutes. The sinus pause usually allows escape beats or rhythms to occur, when other pacemakers in the heart initiate contraction of the ventricles.…”

Section: Sick Sinus Syndromementioning

confidence: 99%

Dual-chamber pacemakers for treating symptomatic bradycardia due to sick sinus syndrome without atrioventricular block: a systematic review and economic evaluation

Edwards¹,

Karner²,

Trevor³

et al. 2015

Health Technol Assess

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BackgroundBradycardia [resting heart rate below 60 beats per minute (b.p.m.)] can be caused by conditions affecting the natural pacemakers of the heart, such as sick sinus syndrome (SSS) and atrioventricular (AV) blocks. People suffering from bradycardia may present with palpitations, exercise intolerance and fainting. The only effective treatment for patients suffering from symptomatic bradycardia is implantation of a permanent pacemaker.ObjectiveTo appraise the clinical effectiveness and cost-effectiveness of dual-chamber pacemakers compared with single-chamber atrial pacemakers for treating symptomatic bradycardia in people with SSS and no evidence of AV block.Data sourcesAll databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Health Technology Assessment database, NHS Economic Evaluations Database) were searched from inception to June 2014.MethodsA systematic review of the clinical and economic literature was carried out in accordance with the general principles published by the Centre for Reviews and Dissemination. Randomised controlled trials (RCTs) evaluating dual-chamber and single-chamber atrial pacemakers and economic evaluations were included. Pairwise meta-analysis was carried out. A de novo economic model was developed.ResultsOf 493 references, six RCTs were included in the review. The results were predominantly influenced by the largest trial DANPACE. Dual-chamber pacing was associated with a statistically significant reduction in reoperation [odds ratio (OR) 0.48, 95% confidence interval (CI) 0.36 to 0.63] compared with single-chamber atrial pacing. The difference is primarily because of the development of AV block requiring upgrade to a dual-chamber device. The risk of paroxysmal atrial fibrillation was also reduced with dual-chamber pacing compared with single-chamber atrial pacing (OR 0.75, 95% CI 0.59 to 0.96). No statistically significant difference was found between the pacing modes for mortality, heart failure, stroke, chronic atrial fibrillation or quality of life. However, the risk of developing heart failure may vary with age and device. The de novo economic model shows that dual-chamber pacemakers are more expensive and more effective than single-chamber atrial devices, resulting in a base-case incremental cost-effectiveness ratio (ICER) of £6506. The ICER remains below £20,000 in probabilistic sensitivity analysis, structural sensitivity analysis and most scenario analyses and one-way sensitivity analyses. The risk of heart failure may have an impact on the decision to use dual-chamber or single-chamber atrial pacemakers. Results from an analysis based on age (> 75 years or ≤ 75 years) and risk of heart failure indicate that dual-chamber pacemakers dominate single-chamber atrial pacemakers (i.e. are less expensive and more effective) in older patients, whereas dual-chamber pacemakers are dominated by (i.e. more expensive and less effective) single-chamber atrial pacemakers in younger patients. However, these results are based on a subgroup analysis and should be treated with caution.ConclusionsIn patients with SSS without evidence of impaired AV conduction, dual-chamber pacemakers appear to be cost-effective compared with single-chamber atrial pacemakers. The risk of developing a complete AV block and the lack of tools to identify patients at high risk of developing the condition argue for the implantation of a dual-chamber pacemaker programmed to minimise unnecessary ventricular pacing. However, considerations have to be made around the risk of developing heart failure, which may depend on age and device.Study registrationThis study is registered as PROSPERO CRD42013006708.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Sick Sinus Syndromementioning

confidence: 99%

Dual-chamber pacemakers for treating symptomatic bradycardia due to sick sinus syndrome without atrioventricular block: a systematic review and economic evaluation

Edwards¹,

Karner²,

Trevor³

et al. 2015

Health Technol Assess

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“…Sinus node dysfunction or sick sinus syndrome (SSS) may clinically manifest as sinus bradycardia, sinus arrest, sinoatrial exit block, or tachy-brady syndrome [91]. Most cases are due to age-related, idiopathic degenerative fibrosis of the sinoatrial node [92].…”

Section: Sick Sinus Syndrome and Atrioventricular Blockmentioning

confidence: 99%

Impact of Sex and Ethnicity on Arrhythmic Risk

Rane

Patton

2015

Curr Cardiol Rep

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Substantial differences in the risk of common arrhythmia syndromes exist between men and women, as well as in varying ethnic/racial groups. For example, despite an overall lower risk of sudden death and atrial fibrillation in women compared with men, women have longer QT intervals and a higher risk of torsades de pointes due to antiarrhythmic drugs and worse outcomes associated with atrial fibrillation. An ethnicity-related paradox in atrial fibrillation epidemiology is apparent; despite a higher prevalence of medical comorbidities such as hypertension, diabetes, and prolonged PR interval, blacks, Hispanics, and Asians have a lower risk of atrial fibrillation than whites. In this promising era of genomic medicine, an improved understanding of epidemiology and phenotype holds the potential for revealing novel therapeutic targets and preventing disease.

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“…It often manifests as sinus bradycardia, sinus arrest, sino-atrial exit block, alternating brady/tachyarrhythmia or atrial fibrillation [21]. Specifically, the risk of atrial fibrillation in patients with SND is at least 1 in 3 with long-term follow-up [22].…”

Section: Sinus Node Disease: An Atrial Myopathymentioning

confidence: 99%