When there is no extrinsic cause, an intrinsic/organic cause is assumed. įunctional (secondary) sick sinus syndrome is distinguished from a true (primary) sinus node disorder by its extrinsic causes, such as myocardial infarction, electrolyte disturbances, autonomic dysregulation, or adverse drug reactions. Treating symptomatic sinus node disease by permanent pacemaker implantation, preferably dual chamber, is strongly recommended (IB) by the European Society of Cardiology (ESC) guidelines. Cranial MRI could aid the diagnostic workup of such cases.Īlongside higher grade atrioventricular block and atrial fibrillation with symptomatic bradycardia, one of the leading indications for permanent pacemaker implantation is sinus node disease. Intracerebral tumors should be considered in the differential diagnosis for patients with unexplained sinoatrial block, as well as in patients with repeat syncope after pacemaker implantation. Six months later, stage IV glioblastoma was diagnosed and the patient was treated surgically. Further neurologic testing revealed focal epilepsy. Postoperatively, syncope occurred again due to a focal seizure during which sinus rhythm transitioned to atrial pacing by the device. Neurologic exams (including CT and EEG) revealed no pathologies, so a pacemaker was implanted. Case presentationĪ 50-year-old patient with syncope and documented sinoatrial arrest was referred. The most frequent causes of sinus node disease treated with pacemaker implantation involve degenerative structural changes of the sinus node less often, extrinsic causes (such as damage due to myocardial infarction or heightened parasympathetic nervous system activity) lead to pacemaker implantation. Atrial fibrillation with symptomatic bradycardia, higher grade atrioventricular block, and sinus node disease are all common indications for permanent pacemaker implantation.
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