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Clinical review of sick sinus syndrome and atrial fibrillation

Klinischer Überblick über das Syndrom des kranken Sinusknotens und Vorhofflimmern

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Abstract

Sick sinus syndrome (SSS) is a set of diseases with abnormal cardiac pacing, which manifests as diverse cardiac arrhythmias, especially bradycardia. The clinical presentation is inconspicuous in the early stage, but with the progression of this disease, patients may present with symptoms and signs of end-organ hypoperfusion. As a common result in the natural history of the disease, SSS coexisting with atrial fibrillation (AF) forms the basis of bradycardia–tachycardia syndrome. Age-related interstitial fibrosis is considered to be the common pathophysiological mechanism between SSS and AF. The combination of these diseases will adversely affect the condition of patients and the efficiency of subsequent treatment. Although the exact mechanism is not clear to date, the extensive structural and electrical remodeling of the atrium are considered to be the important mechanism for the occurrence of AF in patients with SSS. Pacemaker implantation is the first-line treatment for symptomatic patients with SSS and documented bradycardia history. In view of the adverse effects of AF on the treatment of SSS, researchers have focused on evaluating different pacing modes and algorithms to reduce the risk of AF during pacing. Catheter ablation may also be used as an alternative second-line therapy for some patients with SSS and AF.

Zusammenfassung

Das Syndrom des kranken Sinusknotens („sick sinus syndrome“ [SSS]) setzt sich aus einer Reihe von Erkrankungen mit anomaler Schrittmacherfunktion des Herzens zusammen, was sich in Form verschiedener kardialer Arrhythmien zeigt, insbesondere als Bradykardie. Im Frühstadium sind die klinischen Anzeichen unauffällig, aber mit Fortschreiten der Erkrankung können sich bei den Patienten Symptome einer Endorganhypoperfusion einstellen. Als eine häufige Folge des natürlichen Krankheitsverlaufs bildet das SSS bei gleichzeitigem Vorhofflimmern (VF) die Basis für ein Bradykardie-Tachykardie-Syndrom. Eine altersbezogene interstitielle Fibrose gilt als der gemeinsame pathophysiologische Mechanismus zwischen SSS und VF. Die Kombination dieser Erkrankungen hat negative Auswirkungen auf den Zustand der Patienten und auf die Wirksamkeit der nachfolgenden Behandlung. Zwar ist der genaue Mechanismus bisher noch nicht bekannt, aber das ausgedehnte strukturelle und elektrische Remodeling des Vorhofs werden als die entscheidenden Mechanismen für das Auftreten von VF bei Patienten mit SSS betrachtet. Die Schrittmacherimplantation stellt die Therapie der ersten Wahl bei symptomatischen Patienten mit SSS und dokumentierter Bradykardie in der Vorgeschichte dar. Angesichts der günstigen Auswirkungen von VF auf die Behandlung des SSS lag der Schwerpunkt von wissenschaftlichen Untersuchungen auf der Beurteilung verschiedener Schrittmachermodi und –algorithmen, um das Risiko eines VF während der Schrittmacheraktivität zu vermindern. Als alternative Zweitlinientherapie für manche Patienten mit SSS und VF kann auch eine Katheterablation infrage kommen.

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Acknowledgements

The authors would like to acknowledge Prof. Li for support with this review.

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  1. Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical University, 116027, Dalian, China

    Wenxing Chang MD & Guangsen Li PhD

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W. Chang and G. Li declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Chang, W., Li, G. Clinical review of sick sinus syndrome and atrial fibrillation. Herz 47, 244–250 (2022). https://doi.org/10.1007/s00059-021-05046-x

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