Preface The famous gangs that you often hear about on TV include the Yamaguchi Group, the Chuk Yuen Gang, the Hung Hing Society …… Then do you know how many kinds of sick sinus syndrome there are?
Sinus node is the boss of heart rhythm origin, sick sinus syndrome as the name implies is sick sinus node, but this disease is also divided into factions. According to the electrocardiogram and clinical characteristics, the sick sinus node syndrome is typed in order to facilitate clinical diagnosis and selection of treatment plan. Ding Chunhua, Cardiac Arrhythmia Treatment Center, Guangdong Provincial Hospital of Traditional Chinese Medicine
I. Slow type (classic sick sinus syndrome)
This is a completely declining gang, from the boss to the staff are all disillusioned, everyone is thinking of retirement, the whole a “tree down the sinking ship” weather.
The lesion is confined to the sinus node itself and is characterized by sinus rhythm disturbances due to sinus node pacing or (and) conduction dysfunction.
2. Electrocardiographic manifestations
(1) Sinus bradycardia (sinus bradycardia): heart rate <50 beats/min for most of 24 h, total ECG beats <80,000/24 h.
(2) Primary sinus arrest (sinus arrest): The duration of arrest is often >2 s.
(3) Sinus atrioventricular block: Second degree sinus block is common.
3. Clinical manifestations vary in severity and severity. Mild cases may be asymptomatic or vague; severe cases may show signs of insufficient blood supply to the heart, brain and kidneys. Cerebral ischemia is often manifested as transient dizziness, blackness, or even syncope (A-Syndrome) or sudden death.
4. Treatment
(1) Drugs: Oral theophylline, scopolamine or atropine can be given. In acute cases, atropine (1~2mg iv) or pumped isoprenaline (0.5mg in 500ml 5% GS, titration adjustment, can be adjusted by pump 1~2μg/min to start) should be injected sedately.
(2) Pacemaker: In principle, AAI pacemakers should be placed in all chronic patients with symptoms, but in view of the risk of future atrial fibrillation and atrioventricular block, implantation of a DDD pacemaker is more appropriate. If a DDD pacemaker is placed, the AV interval should be extended or programmed to AAI or DDI mode. In cases of temporal insufficiency, an AAIR or DDDR pacemaker should be placed. In patients with acute myocardial infarction, acute myocarditis, or antiarrhythmic drug intoxication, temporary VVI pacing is indicated.
II. Slow-fast type (slow-fast syndrome)
The boss has the heart but not the power, his men usurp the power and take over the position, a gang that is ready to rebel.
1. The lesion site lesion is not only in the sinus node itself, but also spreads to the perisinus node area, atrial muscle or intra-atrial conduction system.
2. The electrocardiogram and clinical manifestations are accompanied by various atrial tachyarrhythmias such as paroxysmal atrial tachycardia, paroxysmal atrial flutter or paroxysmal atrial fibrillation on top of sinus bradycardia, sinus arrest or sinus block. The termination of tachyarrhythmias is often accompanied by slow arrhythmias, such as prolonged sinus arrest or severe sinus bradycardia. Depending on the type of arrhythmia, there may be different clinical symptoms.
3. Treatment
(1) Pacemaker placement with antiarrhythmic drugs.
(2) Catheter ablation on the basis of pacemaker placement: catheter ablation should be performed for those whose rapid arrhythmia drug therapy is ineffective or has negative effects.
Fast-slow type ( fast-slow syndrome)
This boss is strong, the gang usually seems to be a peaceful, riot up the boss is unable to suppress.
1. Electrocardiogram and clinical manifestations
(1) Usually normal sinus rhythm, no evidence of primary sinus arrest and sinus block.
(2) There are paroxysmal atrial tachycardia, atrial flutter or atrial fibrillation and other rapid atrial arrhythmias, all occurring on the basis of normal rhythm.
(3) Rapid atrial arrhythmias (especially paroxysmal atrial fibrillation) are terminated with manifestations of transient sinus node depression, such as severe sinus arrest or sinus bradycardia, which may result in dizziness, chest tightness, blackness, or even syncope.
2. Mechanism of occurrence
(1) Rapid atrial arrhythmias: Cardiac electrophysiological markers confirm that atrial arrhythmias are mostly associated with electrical activity originating in the pulmonary veins or the internal muscle sleeves of the superior vena cava driving and triggering the atria.
(2) Sinus node inhibition: It is not known, but it is possible that the rapid atrial rate during atrial fibrillation episodes causes local release of acetylcholine from the atrial muscle, which accumulates locally and increases K+ efflux from the sinoatrial node pacing cells, resulting in increased extracellular K+ concentration, increased negative diastolic potential, decreased action potential phase 4 slope, and decreased autoregulation of the sinoatrial node cells.
3. Treatment
(1) Catheter ablation: Catheter ablation is preferred for paroxysmal tachyarrhythmias, with an overall success rate of more than 90%, and has become the main treatment. After successful ablation, most of them do not require pacemaker placement, but for the rare cases with symptomatic slow arrhythmias after ablation, pacemaker placement is feasible.
(2) Pacemaker and antiarrhythmic drugs: For those who have contraindications to catheter ablation or who are unwilling to undergo reablation after recurrence of atrial fibrillation after catheter ablation, antiarrhythmic drugs can be added after pacemaker placement to maintain sinus rhythm.
References.
1. Cui Junyu. Typing and treatment of pathological sinus node syndrome [J]. Journal of Electrocardiography (electronic version), Vol. 2, No. 2, May 2013
2. Shirley A. Jones. ECG Notes Interpretationand Management Guide[M]. F.A. Davis Company – Philadelphia
3. Guo JH, Zhang P. Dynamic electrocardiography [M]. People’s Health Publishing House. 2003.
The Cardiac Arrhythmia Center of University City Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine specializes in the treatment of slow arrhythmias with a combination of Chinese and Western medicine, including classical Chinese herbal formulas and pacemaker implantation.
The Cardiac Arrhythmia Center has 21 beds, one person with a senior title, one doctoral supervisor, three attending physicians, two post-doctors and three masters. It also has a cardiac electrophysiology research laboratory, which conducts research on arrhythmia diseases and drug development by using the international leading equipment such as optical marker measurement.
Interventional procedures are carried out for
1. Atrial fibrillation (AF), atrial flutter (AF), atrial tachycardia (AT), premature atrial contraction (PM)
2. Paroxysmal supraventricular tachycardia (supraventricular tachycardia)
3. Pre-excitation syndrome
4. Ventricular tachycardia (ventricular tachycardia), premature ventricular contractions (premature ventricular contractions)
5. Syncope or dizziness/fainting
6. Pacemaker therapy for slow arrhythmias
7. Ventricular resynchronization for heart failure
8. ICD for malignant arrhythmias
9. Intracardiac electrophysiological examination for familial, congenital or complex ECG, etc.
Traditional Chinese medicine features: the use of traditional Chinese medicine prescriptions, auricular acupuncture, abdominal acupuncture, body acupuncture, acupuncture point application, foot massage, etc. combined with medicinal food conditioning comprehensive treatment of cardiac arrhythmias.