Bernard H. Boal

A study of patients with the sick sinus syndrome with long-term survival

Abstract Seven of 167 patients (4.2%) with a Sick Sinus Syndrome were observed for a minimum of 15 and a maximum of 35 yr after the onset of their sinoatrial disorder. Five of the seven had no discernible cardiac disease, one had mitral stenosis and one had repair of an atrial septal defect. All had normal heart size and no evidence of intrinsic myocardial desease. Five of the seven patients had cerebral symptoms and required cardiac pacing. The remaining two had palpitations associated with a tachyarrhythmia but the bradyarrhythmias were asymptomatic and did not need pacing. No patient had congestive heart failure or angina. Initially only two patients had both tachycardias and bradycardias. Subsequently six of the seven were found to have the tachycardia-bradycardia syndrome. The long survival of the seven patients is attributed to the presence of good myocardial function and the absence of serious myocardial disease. Neither cerebral symptoms nor associated tachyarrhythmias appeared to influence survival.

Symptomatic Improvement in a Patient with Sick Sinus Syndrome After the Onset of Stable Atrial Flutter

A patient with sick sinus syndrome (SSS) presented with episodic lightheadedness and weakness. The electrocardiographic features were marked supraventricular bradyarrhythmias and paroxysmal atriai flutter. The symptoms lested for four years and disappeared with the onset of stable atrial flutter which has persisted for the past seven years. Over the 11‐year period of observation, there has been progressive involvement of the His‐Purkinje system manifested by the development of left anterior fascicular block, right bundle‐branch block, and prolongation of the HV conduction time. The patient has refused pacemaker implantation, In the absence of angina and in the presence of a normal heart size, the etiology of his SSS is postulated to be idiopathic fibrosis of his conduction system.