Sinus node dysfunction is an abnormality in the natural pacemaker of the heart that generally causes a slow heart rate.
People may have no symptoms, or they may feel weak or tired, have palpitations or light-headedness, or even faint.
Electrocardiography is used to make the diagnosis.
A permanent artificial pacemaker is usually needed.
(See also Overview of Abnormal Heart Rhythms.)
Dysfunction of the heart’s natural pacemaker (the sinus or sinoatrial node) may result in a persistently slow heartbeat (sinus bradycardia) or complete cessation of normal pacemaker activity (sinus arrest—see figure Tracing the Heart's Electrical Pathway). When activity ceases, another area of the heart usually takes over the function of the sinus node. This area, called an escape pacemaker, may be located lower in the atrium, in the atrioventricular node, in the conduction system, or even in the ventricle.
All types of sinus node dysfunction are more common among older adults. Some medications and an underactive thyroid gland (hypothyroidism) can cause sinus node dysfunction. However, the cause is usually unknown. When the cause is unknown, the disorder is called sick sinus syndrome.
An important subtype of the sick sinus syndrome is the bradycardia-tachycardia syndrome, in which periods of slow heart rhythms (bradycardia) alternate with periods of fast atrial arrhythmias (tachycardia), such as atrial fibrillation and atrial flutter.
Sinus node dysfunction affects mainly older adults, especially those with another heart disorder or with diabetes. The most common cause is formation of scar tissue (fibrosis) in the sinus node. The cause of fibrosis is usually unknown, but known causes of sinus node dysfunction include the following:
Medications (for example, beta-blockers and other medications used for abnormal heart rhythms)
Excessive impulses from the vagus nerve, which inhibit the heartbeat
Disorders that limit blood flow (for example, coronary artery disease)
Disorders cause inflammation (for example, rheumatic fever or inflammation of the heart muscle, called myocarditis)
Symptoms of Sinus Node Dysfunction
Many types of sinus node dysfunction cause no symptoms. A persistent slow heart rate commonly causes weakness and tiredness. Fainting may occur if the rate becomes very slow.
A fast heart rate is often perceived by the person as palpitations. When the fast heart rate stops, fainting may occur if the sinus node is slow in restarting normal heart rhythm.
Diagnosis of Sinus Node Dysfunction
Electrocardiography
A slow pulse (especially an irregular one), a pulse that varies greatly without any change in the person’s activity, or a pulse that does not increase during exercise suggests sinus node dysfunction. Doctors can usually diagnose sinus node dysfunction based on symptoms and the results of electrocardiography (ECG), particularly when heart rhythm is recorded continuously at home over a 24 or 48-hour period using a Holter monitor or an event monitor.
Treatment of Sinus Node Dysfunction
Inserting an artificial pacemaker
People with symptoms are usually given a permanent artificial pacemaker to accelerate the heart rate. If they also sometimes have a fast heart rate, they may also need medications to slow the heart rate (such as a beta-blocker or a calcium channel blocker—see table Some Medications Used to Treat Arrhythmias).
More Information
The following English-language resource may be useful. Please note that The Manual is not responsible for the content of this resource.
American Heart Association: Arrhythmia: Information to help people understand their risks of arrhythmias as well as information on diagnosis and treatment
