How is sinus node dysfunction (SND) treated?

Updated: Nov 30, 2018
  • Author: Bharat K Kantharia, MD, FRCP, FAHA, FACC, FESC, FHRS; Chief Editor: Mikhael F El-Chami, MD  more...
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Answer

See also the Guidelines section for recommendations from the American College of Cardiology, the American Heart Association, and the Heart Rhythm Society for the evaluation and management of bradycardia and disorders of cardiac conduction delay.

The only effective medical care in patients with sinus node dysfunction (SND) is correction of extrinsic causes. Admit patients for testing and pacemaker placement when indicated. Transfer patients for complicated dysrhythmias and pacemaker implantation.

No treatment is required for asymptomatic patients, even if they have abnormal SN recovery times (SNRTs) or sinoatrial conduction times (SACTs). If the patient is receiving medications that can provoke sinus bradyarrhythmias (eg, beta blockers), the medications should be stopped if possible.

Acute treatment consists of atropine (0.04 mg/kg intravenously [IV] every 2-4 h) and/or isoproterenol (0.05-0.5 mcg/kg/min intravenously [IV]). A transvenous temporary pacemaker is sometimes required despite medical therapy.

In patients with bradyarrhythmias-tachyarrhythmias, the tachyarrhythmias may be controlled with digoxin, propranolol, or quinidine. However, these patients should be monitored closely with frequent Holter monitoring to ensure that the bradyarrhythmias are not exacerbated or causing symptoms (eg, dizziness, syncope, congestive heart failure); if exacerbation of arrhythmias or symptoms occur, permanent pacemaker therapy is also required.


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