Syncope: occurred in half of patients with sick sinus syndrome.

Clinical bottom line (level 4)

  1. Three quarters of patients with sick sinus syndrome were symptomatic- commonly with syncope, palpitations or light-headedness.
Rubenstein et al: Circulation 1972; 46: 5-11
Expires June 2004

The study

Case series with unblinded, unobjective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital and local private practice, USA

56 patients (aged range 26 to 90 years; mean 65, 55% male) sick sinus syndrome- persistent unexplained bradycardia with or without tachycardic episodes (symptomatic ventricular tachycardia, atrial fibrillation or flutter) or sinus arrest

Excluded if
  • bradycardia probably from medication
  • lack of sufficient clinical data




    • 87% followed for mean 7.4 years
    Outcomes studied:
  • symptomatic
  • syncope
  • light-headedness
  • palpitations
  • dyspnoea and oedema
  • angina
  • fatigue
  • stroke
  • conduction disturbance
  • first degree heart block
  • bundle branch block
  • death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    symptomatic mean 7.4 years 43/56 77%
    (66% to 88%)
    syncope mean 7.4 years 25/56 45%
    (33% to 58%)
    light-headedness mean 7.4 years 15/56 27%
    (15% to 38%)
    palpitations mean 7.4 years 17/56 30%
    (18% to 42%)
    dyspnoea and oedema mean 7.4 years 9/56 16%
    (6.5% to 26%)
    angina mean 7.4 years 6/56 11%
    (2.6% to 19%)
    fatigue mean 7.4 years 6/56 11%
    (2.6% to 19%)
    stroke mean 7.4 years 10/56 18%
    (7.8% to 28%)
    conduction disturbance mean 7.4 years 33/56 59%
    (46% to 72%)
    first degree heart block mean 7.4 years 19/56 34%
    (22% to 46%)
    bundle branch block mean 7.4 years 10/56 18%
    (7.8% to 28%)
    death mean 7.4 years 6/56 11%
    (2.6% to 19%)

    • Clinical definitions and chart notes were used for outcomes.
    • Only one death was thought to be related to arrhythmia.

    Citation

    1. Rubenstein JJ, et al: Clinical spectrum of the sick sinus syndrome. Circulation 1972; 46: 5-11
    Contributor: Bob Phillips and Chris Ball, June 2000
    Reviewer:

    Clinical Question.
    Patient sick sinus syndrome
    Intervention or Exposure prevalence
    Outcome symptoms and outcomes