A 67-Year-Old Man With Palpitations and Syncope

Nazem Akoum, MD, MS; Steven A. Lubitz, MD, MPH; Zachary D. Goldberger, MD, MSc, FACC


February 19, 2019

Editorial Collaboration

Medscape &

Advancing age is associated with an increase in the collagen content of the sinus node.[10] Age is also associated with an increase in the sinoatrial conduction time, another manifestation of sinus node dysfunction. Of note, patients with age-related sinus node fibrosis also demonstrated fibrosis involving the atrioventricular node.[10]

For patients with tachy-brady syndrome and symptoms of both atrial fibrillation and sinus node dysfunction, treatment of both conditions may be necessary. With prolonged pauses causing presyncope or syncope, a pacemaker implantation is performed first to prevent associated injury; atrial fibrillation is addressed as a subsequent step. For patients without prolonged pauses or syncope but with symptomatic bradycardia associated with the use of antiarrhythmic or rate control agents, considering catheter ablation for atrial fibrillation first to allow for removal of these drugs is reasonable. However, patients with extensive sinus node fibrosis may still require permanent pacing despite successful ablation.[9]


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: