External patch recorder or implantable loop recorder.Event monitor or mobile cardiovascular telemetry.Holter monitor or external patch recorder.Second line : ambulatory cardiac monitoring (typically in the following order).Preferred initial diagnostic study: 12-lead ECG.In hemodynamically unstable patients, start immediate treatment for unstable bradycardia without waiting for diagnostic confirmation. Refer for specialist evaluation for alternative diagnoses or advanced diagnostics if symptoms do not correlate with rhythm abnormalities.Obtain additional studies (e.g., nocturnal polysomnography, TTE) as needed.Evaluate all patients for reversible causes of SND: including medication review, BMP, HbA1c, thyroid function tests.Symptoms on exertion: Perform exercise stress test. Inconclusive ECG findings: Perform ambulatory cardiac monitoring.Correlate symptoms with rhythm abnormalities of SND.See also “ Management of bradycardia” for related information. Tachycardia-bradycardia syndrome is a subtype of SND that manifests as alternating episodes of tachycardia and bradycardia and is associated with increased risk of cardiovascular events and mortality. If reversible causes are not present, permanent pacemaker placement is preferred for long-term management of symptomatic patients. Reversible causes of SND should be identified and managed. Unstable bradycardia requires immediate implementation of advanced cardiac life support ( ACLS) measures. Establishing a temporal correlation between symptoms of bradycardia and rhythm abnormalities of SND (e.g., on ECG, stress testing, cardiac monitoring) confirms the diagnosis. Patients typically present with symptoms of end-organ hypoperfusion due to bradycardia (e.g., fatigue, presyncope, syncope, dyspnea on exertion). It can be caused by factors intrinsic to the SA node (e.g., fibrosis of the SA node, infiltrative diseases) or extrinsic factors (e.g., pharmacotherapy with negative chronotropes, hypothyroidism) and most commonly results in bradycardia. The abnormality "blocks" the electrical impulse from continuing through the normal pathways and usually results in a slower heart rate.Sinus node dysfunction (SND), previously called sick sinus syndrome, is an abnormality in sinoatrial (SA) node action potential generation or conduction. Heart block refers to an abnormality in the way electricity passes through the normal electrical pathways of the heart. Blood-thinning medicines might be used to help prevent a stroke. Medicines might be used to prevent the heart from beating too fast. Treatment may include a pacemaker to prevent the heart from beating too slowly. You may have symptoms such as palpitations and lightheadedness. There is a risk of complications with this syndrome. It can occur when the heart's natural pacemaker is damaged. This abnormal heart rhythm problem is often seen in people who have been diagnosed with atrial fibrillation. In tachy-brady syndrome, also called tachycardia-bradycardia syndrome, the heart sometimes beats too quickly (tachy) and sometimes beats too slowly (brady). People with this syndrome can have slow arrhythmias or a combination of fast and slow arrhythmias. Various irregular heart rates (arrhythmias) or combinations of arrhythmias can happen. Sick sinus syndrome happens when the normal pacemaker of the heart (the sinus node) does not work properly. If there is a cause that is identified, that condition may be treated first. If sinus pause occurs often or over an extended period of time, a person may have symptoms now and then and need a pacemaker. Sinus pause (also called sinus arrest)ĭuring a sinus pause, the heart may miss one or more beats because its natural pacemaker fails to activate the electrical system throughout the rest of the heart.ĭepending on the cause, there is a risk of complications with this type of bradycardia. Then a pacemaker may be implanted if there is no cause that can be easily treated. It rarely requires treatment unless it causes symptoms. This type is not likely to cause complications, unless the heart rate is very slow (less than 40 beats per minute). This type of slow heart rate is often seen in healthy, athletic people. When a person has sinus bradycardia, the heart rate is less than 60 beats per minute. Each type carries a specific risk of complications and treatment options. There are several types of slow heart rates (bradycardias or bradyarrhythmias).
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