Sick Sinus Syndrome: Sinus Node Dysfunction in the Elderly ,
Sandeep Khanna, M.D.; Roshni Sreedharan, M.D.; Carlos Trombetta, M.D., M.Ed.; Kurt Ruetzler, M.D.
 Author Notes
From the Departments of General Anesthesiology (S.K., R.S., K.R.), Outomes Research (S.K., K.R.), Critical Care Medicine (R.S.), and Cardiothoracic Anesthesiology (C.T.), Cleveland Clinic Foundation, Cleveland, Ohio.
Competing Interests: The authors declare no competing interests.
Correspondence: Address correspondence to Dr. Khanna: khannas@ccf.org
Anesthesiology Newly Published on October 14, 2019. doi:10.1097/ALN.0000000000003004
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Sick sinus syndrome is a clinical syndrome characterized by sinus node dysfunction. It presents in elderly patients with bradyarrhythmias and nonspecific symptoms such as fatigue or syncope. Consequently, the diagnosis is often overlooked. Anesthesia can unmask sinus node dysfunction, which then manifests as significant atrial dysrhythmias and “rarely” asystole.1–3  The accompanying images demonstrate this circumstance and are from an elderly patient who underwent pericardial drainage under propofol sedation. While marked sinus bradycardia is seen on the preoperative electrocardiogram (top image), the postprocedure electrocardiogram demonstrates supraventricular tachycardia (bottom image A) that eventually transitions to asystole (bottom image B).
Although asymptomatic sinus bradycardia does not necessitate postponement of surgery, presence of a significant bradyarrhythmia requires consultation. Regardless of how slow the heart rate is, a clinically important bradyarrhythmia is distinguished by the presence of symptoms such as syncope, confusion, and dyspnea. Bradycardia-mediated reduction in cardiac output compromises cerebral perfusion, resulting in syncope. Additionally, severe bradycardia increases left ventricular end-diastolic pressure, precipitating pulmonary congestion and dyspnea.