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Sinus Node Dysfunction: Symptoms, Management, and Treatment Options

Sinus Node Dysfunction (SND) is a condition characterized by abnormalities in the normal functioning of the sinus node, resulting in symptoms such as tachycardia, bradycardia, and atrial fibrillation. This article explores the natural course of SND, its structural and temporal characteristics, management options, and the effectiveness of pacing versus AF ablation as treatment approaches.

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Sinus Node Dysfunction: Symptoms, Management, and Treatment Options

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  1. ΝΟΣΟΣ ΤΑΧΥΒΡΑΔΥΚΑΡΔΙΑΣ: ΕΜΦΥΤΕΥΣΗ ΒΗΜΑΤΟΔΟΤΗ Η ΚΑΤΑΛΥΣΗ ΚΟΛΠΙΚΗΣ ΜΑΡΜΑΡΥΓΗΣ; ΓΕΩΡΓΙΟΣ ΣΤΑΥΡΟΠΟΥΛΟΣ ΕΠ.Α ΚΑΡΔΙΟΛΟΓΟΣ ΓΝΘ ΙΠΠΟΚΡΑΤΕΙΟ

  2. SINUS NODE DISFUNCTION Sinus nodedysfunction (SND) comprisesavariety of abnormalities • sinus arrest, • sinus bradycardia, • sinoatrial block • alternating episodes of tachycardia and bradycardia large proportion of SND patients have atrial fibrillation (AF) and prolonged sinus pauses after AF termination`:tachycardia-bradycardia syndrome. natural course • recurrent syncope, • heart failure, • stroke and • atrial fibrillation

  3. Sinus Node Diseasestructural and temporal characteristics • anatomic and structural abnormalities, including atrial enargement,regions of low voltage, and scarring • Wide Spread conduction slowing and anatomically determined conductiondelay • increased right atrial refractoriness. CSNRT was significantly prolonged in patients with SND Other investigators showed that transient sinus node remodelling was induced by 10–15 min of rapid atrial pacing even in patients without sinus node dysfunction Sanders et al Atrial Remodeling in Sinus Node Disease Circulation March 30, 200

  4. PACEMAKER COMPLICATIONS The American Journal of Cardiology Vol. 92 September 15, 2003

  5. PACING INDUCED CARDIOMYOPATHY

  6. Management of AF

  7. Pacing vs AF ablation for tachycardia-bradycardia Syndrome Cure of AF by pulmonary vein isolation helped resolve the clinical manifestations of sick sinus syndrome, suggesting that the occurrence of AF and/or the associated treatment could be partially responsible for sick sinus syndrome. Natale et al. Journal of Cardiovascular Electrophysiology Vol. 15, No. 7, July 2004

  8. All 43 patients in the ABL group fulfilled Class I indication for pacemaker implantation at baseline but they actually underwent AF ablation. Reevaluation after 20.1 9.6 months of follow-up showed that 41 patients ± (95.3%) did no longer need a pacemaker (Class III indication). Total cardiac-related rehospitalization was not significantly different between the two groups (P = 0.921). Tachycardia-related hospitalization was significantly higher in the PM group than the ABL group (14.0% and 0%, P =0.029). More patients in the PM group were on AADs (PM 40.4%, ABL 4.7%, P< 0.001) while sinus rhythm maintenance wasremarkably higher in the ABL group at the end of follow-up (83.7% vs 21.1% in PM group, P< 0.001).

  9. When the indication for permanent pacing was reassessed after 20.1 9.6 months of follow-up, 95.3% ± (41/43) of the patients of the ABL group were no longer indicated permanent pacing (Class III indication) the two patients who received AAD (amiodarone and propafenone, respectively) after ablation did not develop any AAD-related Bradycardia after the procedure Sinus rhythm was maintained in 83.7% in the ABL group and 21.1% in the PM group at the last procedure P< 0.001 42 of 43 (97.7%) patients had avoided the implantation of pacemaker

  10. Pacing vs AF ablation for tachycardia-bradycardia Syndrome AF ablation obviated permanent pacemaker implantations in the majority of the patients with SSS and PAF, and SSS type 1 was a sole factor predicting pacemaker implantations Received: 1 May 2018 / Accepted: 31 August 2018 Heart and Vessels

  11. Pacing vs AF ablation for tachycardia-bradycardia Syndrome Three patients (8%) required pacemaker implantation, one for the gradual progression of sinus dysfunction during a period of 6.5 years and the others for recurrence of TBS 3.5 and 5.5 years after ablation, respectively Progression of sinus node dysfunction can occur after a long period of time despite the elimination of atrial tachyarrhythmia in TBS patients, a careful follow-up is warranted Europace (2014) 16, 208–213 K. Inada et al.

  12. CONCLUSIONS

  13. CONCLUSIONS • catheter ablation of AF seems effective in treating paroxysmal AF-related tachycardia-bradycardia syndrome in terms of restoration of sinus rhythm without necessity of permanent pacing; Curative AF ablation can render patients pacemakerfree • Ablation seems to have higher rates of sinus rhythm maintenance off AADs compared to pacemaker insertion plus AADs; • Patients who undergo pacemaker implantation are associated with more tachyarrhythmia-related hospitalizations than those who undergo AF ablation. • in TBS patients, a longer-careful follow-up is warranted • limitations of ablation approach in terms of types of bradycardia, stage of AF, left atrial size, age and comorbidities, and amount of atrial fibrosis are unknown

  14. AF Treatment is Complex

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