Preface
The famous gangs that you often hear about on TV include the Yamaguchi Group, the Chuk Yuen Gang, and 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 classified in order to facilitate clinical diagnosis and selection of treatment plan.
I. Slow type (classic sick sinus syndrome)
This is a completely declining gang, from the boss to the subordinates are all disillusioned, everyone is thinking of retirement, the whole “fall of a sinking ship” weather.
1, lesion site lesion is limited to the sinus node itself, manifested as sinus node pacing or (and) conduction dysfunction caused by sinus rhythm disorder.
2.Electrocardiogram performance
(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 (sinus 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 cardiac, cerebral and renal insufficiency. 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 taken. In acute cases, atropine (1~2mg iv) or pump isoprenaline (0.5mg in 500ml 5% GS, titration adjustment, can be adjusted by pump 1~2μg/min to start) should be injected quietly.
(2) Pacemakers: In principle, AAI pacemakers should be placed in all chronic patients with symptoms, but in view of the risk of future atrial fibrillation and AV 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, lesion site lesion not only in the sinus node itself, but also spread to the perisinus node area, atrial muscle or intra-atrial conduction system.
2, electrocardiogram and clinical manifestations in sinus bradycardia, sinus arrest or sinus block on the basis of a variety of atrial tachyarrhythmias, such as paroxysmal atrial tachycardia, paroxysmal atrial flutter or paroxysmal atrial fibrillation. 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 can be different clinical symptoms.
3.Treatment
(1) Pacemaker placement with anti-arrhythmic drugs.
(2) Catheter ablation on top of pacemaker placement: catheter ablation should be performed for those whose rapid arrhythmia medication 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 heart rhythm.
(3) Rapid atrial arrhythmias (especially paroxysmal atrial fibrillation) terminate with the manifestation 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 driven and triggered in the atria originating from the pulmonary veins or the internal muscle sleeves of the superior vena cava.
(2) Sinus node inhibition: It is not clear, but it may be due to the rapid atrial rate during atrial fibrillation that causes local release of acetylcholine from the atrial muscle and its local accumulation, which increases the K+ outflow from the sinus node pacing cells and increases the extracellular K+ concentration, increases the negative diastolic potential, decreases the slope of action potential phase 4, and decreases the autoregulation of sinus 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. Most of them do not require pacemaker placement after successful ablation, but for the very few who still have symptomatic slow arrhythmias after ablation, pacemaker placement is feasible.
(2) Pacemakers and antiarrhythmic drugs: For those who have contraindications to catheter ablation or are unwilling to undergo re-ablation after catheter ablation for atrial fibrillation recurrence, antiarrhythmic drugs can be added after pacemaker placement to maintain sinus rhythm.
Interventional procedures are carried out for
1.Atrial fibrillation (AF), atrial flutter (AF), atrial tachycardia (ATR), 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 for slow arrhythmias
7.Ventricular resynchronization for heart failure
8, ICD for malignant arrhythmias
9.Familial, congenital or complex ECG for intracardiac electrophysiological examination, etc.
Chinese medicine features: the use of traditional Chinese medicine prescriptions, ear acupuncture, abdominal acupuncture, body acupuncture, acupuncture point application, foot massage, etc. combined with medicinal food conditioning comprehensive treatment of arrhythmias.