Sinus arrest primarily affects older patients [1]. It may arise either as a manifestation of sinus node dysfunction, as a side effect from certain drugs used to treat cardiovascular diseases (eg. digitalis), as a complication of myocardial ischemia or sleep apnea, and alongside a fibrotic sinoatrial node condition [2] [3].

Depending on whether the arrest lasts for 2 seconds or for a longer period of time, sinus arrest causes symptoms ranging from mild/unnoticed to severe and life-threatening. Patients diagnosed with the condition usually belong to the senior age group and exhibit various comorbidities. The most common manifestations associated with sinus arrest include syncope, light-headedness, loss of orientation, weakness, angina, and heart failure [4] [5] [6]. Loss of consciousness experienced by a patient due to sinus arrest is known as Adam-Stokes attack. Oliguria may also complicate the clinical picture.

Sinus arrest during periictal period has been observed by a study to frequently arise in patients with inadequately controlled epilepsy [7]. In a typical sinus arrest case, should the electrical activity be paused for too long, different cellular groups will undertake the pacemaking responsibility until the sinoatrial node recovers. If that does not happen, sinus arrest can lead to hypoxia, multiple organ system failure, and cardiac arrest.

• Fatigue

  A young asymptomatic male athlete came to our laboratory to be enrolled in a research protocol on physical fatigue. Routine clinical and cardiological evaluations including echocardiogram were in the normal range. [ncbi.nlm.nih.gov]

  Senior individuals who present with symptoms possibly originating from the cardiovascular system, such as angina, loss of consciousness, and fatigue, should always undergo an electrocardiographic evaluation. [symptoma.com]

  (palpitations) When to see a doctor If you have lightheadedness, dizziness, fainting, fatigue, shortness of breath or palpitations, talk to your doctor. [mayoclinic.org]

  A disorder characterized by a dysrhythmia with alternating periods of bradycardia and atrial tachycardia accompanied by syncope, fatigue and dizziness. [icd10data.com]

  […] produce no symptoms, a person may present with one or more of the following signs and symptoms: Stokes-Adams attacks – fainting due to asystole or ventricular fibrillation Dizziness or light-headedness Palpitations Chest pain or angina Shortness of breath Fatigue [en.wikipedia.org]

• Epilepsy

  Some forms of focal epilepsy, including temporal lobe epilepsy, are rarely associated with ictal bradycardia and sinus node arrest. We report a case of a previously healthy man presenting with syncope in whom telemetry revealed sinus arrest. [ncbi.nlm.nih.gov]

  Surgical treatment of the epilepsies, 2nd ed. New York: Raven Press, 1993:377–386. 2. Wyler AR. Subdural strip electrodes in surgery of epilepsy. In: Lüders H, ed. Epilepsy surgery. New York: Raven Press, 1991:395–398. 3. [jaccr.com]

  Sinus arrest during periictal period has been observed by a study to frequently arise in patients with inadequately controlled epilepsy. [symptoma.com]

  The authors report three episodes of severe bradycardia and sinus arrest that occurred in a patient undergoing anterior temporal lobectomy and amygdalo-hippocampectomy for the treatment of epilepsy. [journals.lww.com]

• Nausea

  Among the common adverse effects associated with sertraline are nausea, insomnia, diarrhea, somnolence, and dizziness. Cardiac arrest had not been reported in the literature, although tachycardia was frequently seen. [ncbi.nlm.nih.gov]

  […] person may present with one or more of the following signs and symptoms: Stokes-Adams attacks – fainting due to asystole or ventricular fibrillation Dizziness or light-headedness Palpitations Chest pain or angina Shortness of breath Fatigue Headache Nausea [en.wikipedia.org]

  […] placed in the recovery position and stimulation manoeuvres were attempted while resuscitation drugs were being prepared; however, after 38 s his heart returned to sinus rhythm at a rate of 140 bpm and he regained consciousness describing a feeling of nausea [casereports.bmj.com]

• Vomiting

  Symptoms include: chest pain difficulty breathing profuse sweating dizziness pain or discomfort in the upper body mental confusion or panics abdominal pain dizziness vomiting blackouts See your doctor as soon as possible if you’re experiencing any symptoms [healthline.com]

• Heart Disease

  After 38 s, his heart returned to sinus rhythm at a rate of 140 bpm and he regained consciousness. Vasovagal syncope following exercise in the absence of structural heart disease is uncommonly reported. [ncbi.nlm.nih.gov]

  In our patient, structural heart disease was excluded by transthoracic echocardiography. There were no features in the history to indicate coronary artery disease for which he had minimal risk factors. [casereports.bmj.com]

  Risk factors for SSS include: history of congenital heart disease (even with repairs, the heart is still weak) thyroid disease history sleep apnea disorder coronary artery disease: the coronary artery becomes clogged, and blood flow to the heart is restricted [healthline.com]

• Heart Block

  The number of episodes of heart block during sleep decreased significantly (p < 0.001) from 1,575 before therapy to 165 during nCPAP. In 12 patients (70.6%) heart block was totally prevented by nCPAP. [ncbi.nlm.nih.gov]

  High Grade AV Block • At least 2 consecutive non-conducted P waves (3:1 AV Block) • Also called “advanced second-degree heart block” • Look at the PR interval of conducted beats: should be constant 19. 4:1 AV block 20. 3rd Degree or Complete Heart Block [slideshare.net]

  Conduction through the AV node can either be delayed (1st degree heart block), partially blocked (2nd degree heart block) or completely blocked (3rd degree heart block). [fastbleep.com]

• Slow Pulse

  Symptoms of SSS include: fainting or fainting sensations fatigue dizziness palpitations (abnormal heart beats) very slow pulse (bradycardia) difficulty breathing chest pain mental confusion memory problems disrupted sleep It’s important to see your doctor [healthline.com]

• Skipped Beats

  Patients who have sinus pauses may complain of missed or skipped beats, flutters, palpitations, hard beats or may feel faint, dizzy or lightheaded or experience a syncopal episode (passing out). Frequent pauses would heighten these symptoms. [equimedcorp.com]

• Seizure

  In contrast to the usual occurrence of tachycardia during epileptic seizures, a 23-year-old man had episodic prolonged sinus arrest that lasted up to 9 seconds at the time of clinically observed seizures. There was no demonstrable cardiac disease. [ncbi.nlm.nih.gov]

  Although, surgery is meant to eradicate seizures, it is not uncommon to have seizures in the early post-operative period so these seizures should be managed by optimizing the antiepileptic drug levels, however these early seizures has no implications [jaccr.com]

  […] at the time of clinically observed seizures. [n.neurology.org]

  The seizures occurred after crying, pain, or frustration. [circ.ahajournals.org]

• Irritability

  FOS gained popularity due to its water solubility, which allows 3 times faster infusion in comparison with PTN with less venous irritation and local toxicity. [ncbi.nlm.nih.gov]

  Atrial Premature Beat Atrial premature beat (APB) arises from an irritable focus in one of the atria. [medicine-on-line.com]

  Ischemic hearts are electrically irritable. Under these conditions, reverberating circuits can be set up and rapid fire discharges can occur from an irritable focus. [jan.ucc.nau.edu]

  Recently, pro drugs of phenytoin have been synthesized that are more soluble and less irritating to the tissues. These agents are presently being field tested and may become the standard of care in future. [jaccr.com]

  The condition often goes undetected in the early stages because only sinus bradycardia may be present at its origin. 9 Some symptoms of patients with sick sinus syndrome (e.g., fatigue, irritability, memory loss, lightheadedness, palpitations, cognitive [aafp.org]

• Somnolence

  Among the common adverse effects associated with sertraline are nausea, insomnia, diarrhea, somnolence, and dizziness. Cardiac arrest had not been reported in the literature, although tachycardia was frequently seen. [ncbi.nlm.nih.gov]

Sinus arrest is detected via a 12-lead electrocardiogram. Senior individuals who present with symptoms possibly originating from the cardiovascular system, such as angina, loss of consciousness, and fatigue, should always undergo an electrocardiographic evaluation.

A typical sinus arrest electrocardiogram (ECG) will reveal an absence of P waves, with a duration ≥ 2 seconds. Of note, the length of the pause cannot be expressed as a multiple of the basic sinus cycle length. Occasionally and when the P waves are absent for a relatively long time, escape beats appear, as other groups of myocardial cells undertake the pacemaking process for a brief period of time. The R-R interval before and after sinus arrest is stable.

Given that sinus arrest occurs as a result of sinus node dysfunction, myocardial ischemia, certain drugs, and other causes, these need to be investigated as well. Laboratory tests can illustrate a potential hyperkalemia, the ECG will also diagnose ongoing ischemic alterations of the myocardium, and ambulatory or long-term ECG monitoring can also be employed in order to investigate the presence of an underlying pathology and confirm where the symptoms originate from [8].

• Sinus Arrest

  If that does not happen, sinus arrest can lead to hypoxia, multiple organ system failure, and cardiac arrest. Sinus arrest is detected via a 12-lead electrocardiogram. [symptoma.com]

  Even though sinus arrest is caused by the occlusion of the SN artery, this bradyarrhythmia seems to disappear in the short term. [ncbi.nlm.nih.gov]

• Sinus Arrhythmia

  […] rhythm is irregular (sinus arrhythmia), sinus arrest can't be differentiated from sinus block, and the rhythm is interpreted as sinus arrhythmia with sinus pause. [aibolita.com]

  Or just simple sinus "arrhythmia" (benign, vagally induced)? Sinus arrhythmia is unlikely because, in sinus arrhythmia, the rate usually gradually slows and then gradually speeds up. [hqmeded-ecg.blogspot.com]

  Three months later, several long-term ECG recordings showed sinus arrhythmia with no evidence of sinus arrest or AV-nodal escape rhythm, so that the DDD pacemaker was turned off. [ncbi.nlm.nih.gov]

  Related Topics Sinus Bradycardia Sinus Arrhythmia Sinoatrial Exit Block References Da Costa D, Brady WJ, Edhouse J. Bradycardias and atrioventricular conduction block. [lifeinthefastlane.com]

• Premature Atrial Contractions

  Premature atrial contractions (PACs), also known as atrial premature complexes (APC) or atrial premature beats (APB), are a common cardiac arrhythmia characterized by premature heartbeats originating in the atria. [allnurses.com]

  Premature atrial contractions 3. Nonconducted premature atrial contractions 4. Atrial tachycardia 5. Paroxysmal atrial tachycardia 6. Supraventricular tachycardia 7. Atrial flutter 8. Atrial fibrillation IX. Wandering Atrial Pacemaker A. [andrews.edu]

  Premature Atrial Contractions or Atrial Premature Beats (PAC's or APB's) : This is a single premature beat meaning that it occurs earlier than expected. [jan.ucc.nau.edu]

• P Wave Absent

  This results in an absent PQRST complex. The pause is the same as the distance between two P-P intervals of the underlying rhythm. [ceufast.com]

  QRS: absent 4. P wave: abnormal in size, shape, deflection, or may be hidden in the preceding T wave distorting the T wave contour 5. PR interval: absent 6. Interpretation: Underlying rhythm with Nonconducted PAC XII. Atrial Tachycardia A. [andrews.edu]

• Absent A-Waves

  ECG Features: A widened QRS complex A secondary R' wave in V6 Absent Q waves in V5/V6 NB: In LBBB the ST segments displace in the opposite direction to the (overall) direction of the preceeding QRS complex. [fastbleep.com]

  ECG Examples Example 1 Sinus arrest: Prolonged absence of sinus node activity (absent P waves) > 3 seconds. Example 2 Bradycardia-tachycardia syndrome: Runs of tachycardia interspersed with long sinus pauses (up to 6 seconds). [lifeinthefastlane.com]

In this case report, a patient was presented who had adverse reactions such as nausea, dizziness, insomnia under citalopram treatment, and after his drug was changed to sertraline, developed sinus arrest on the fourth day of treatment. [ncbi.nlm.nih.gov]

Breath-holding spells is a relatively common disorder in young children that usually spontaneously resolves and needs no treatment. [circ.ahajournals.org]

Treatment and prognosis depend on the cause and cardiac status of the patient. This condition may be drug induced or it may be a result of cardiac disease. [equimedcorp.com]

Prognosis of sinus node dysfunction is mixed; without treatment, mortality is about 2%/yr, primarily resulting from an underlying structural heart disorder. Each year, about 5% of patients develop AF with its risks of heart failure and stroke. [merckmanuals.com]

After reviewing the literature and discussing possible etiologies for this unusual adverse drug reaction in this setting, we recommend that metoclopramide be used with caution in patients prone to develop bradyarrythmias, particularly those with dysautonomias [ncbi.nlm.nih.gov]

0.11 sec or less Etiology May occur with hypoxia, myocardial ischemia or infarction, hyperkalemia, medications (beta blockers, calcium channel blockers), and increased vagal tone Conduction SA node fails to initiate electrical impulse for one or more [ecgreview.weebly.com]

Etiology of sinus pauses and arrest: alteration in the impulse rate of the P cells. Therefore, the pause length is variable and not necessarily a multiple of the basic sinus rate. [hqmeded-ecg.blogspot.com]

This is further evidence for its etiologic role in intravenous phenytoin toxicity, a phenomenon which is almost always related to infusion rate. The ethanol intravenous diluent fraction may precipitate a reaction in patients taking disulfiram [13]. [jaccr.com]

Only a few epidemiologic studies have been published. [emedicine.medscape.com]

Epidemiology [ edit ] Sick sinus syndrome is a relatively uncommon syndrome in the young and middle-aged population. [en.wikipedia.org]

Epidemiology and burden of nasal congestion. Stewart M, Ferguson B, Fromer L. Int J Gen Med. 2010 Apr 8;3:37-45. 28. De la rhinite allergique aux pathologies sinusiennes (sinusite/polypose) : les liens épidémiologiques et expérimentaux. P. Demoly. [passeportsante.net]

/Richard Parad (US) The arguments for and against a safety net strategy in the NBS protocol - Olaf Sommerburg (DE) Newborn screening in Australia, investigating alternative strategies such as PAP - Enzo Ranieri (AU) 08:30-10:00 Symposium 4 - Beyond Epidemiology [ecfs.eu]

It is therefore suggested that the underlying pathophysiology involved autonomic dysfunction. [ncbi.nlm.nih.gov]

It is therefore suggested that the underlying pathophysiology involved autonomie dysfunction. [nejm.org]

Pathophysiology of isolated systolic hypertension in elderly patients: Doppler echocardiographic insights. [health.usf.edu]

Pathophysiology The sinus node (SN) is a subepicardial structure normally located in the right atrial wall near the superior vena cava entrance on the upper end of the sulcus terminalis. [emedicine.medscape.com]

This report emphasizes that a sphenopalatine ganglion blockade can be employed in the treatment and prevention of sinus arrest associated with postherpetic trigeminal distribution neuralgia. [ncbi.nlm.nih.gov]

Compared to placebo, the drug phenytoin (PHY) has been reported to be significantly more effective in preventing post traumatic seizures during the first 7 days [5]. [jaccr.com]

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3. Alonso A., Jensen P. N., Lopez F. L., et al. Association of sick sinus syndrome with incident cardiovascular disease and mortality: the atherosclerosis risk in communities study and cardiovascular health study. PLoS ONE. 2014;9:e109662.
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6. New York Heart Association. Criteria Committee.Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. Criteria, 8th ed. Boston, MA: Little Brown & Co., Boston;1979.
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8. Crawford MH, Bernstein SJ, Deedwania PC, et al. ACC/AHA guidelines for ambulatory electrocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the Guidelines for Ambulatory Electrocardiography). Developed in collaboration with the North American Society for Pacing and Electrophysiology. J Am Coll Cardiol. 1999;34 (3):912-948.