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Sick sinus syndrome in children can be life-threatening, causing neurological symptoms and sudden death. Early diagnosis and pacemaker insertion are crucial for managing this pediatric cardiac arrhythmia.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Cardiac Arrhythmias
Background:
- Sick sinus syndrome (SSS) is a rare cardiac arrhythmia affecting the heart's natural pacemaker.
- While often associated with older adults, SSS can occur in children, presenting unique diagnostic and management challenges.
Observation:
- This study describes five pediatric cases of SSS with otherwise normal hearts.
- Symptoms ranged from bradycardia noted prenatally to neurological manifestations like syncope and dizziness.
- One case involved sudden death, and another experienced near-fatal ventricular tachycardia.
Findings:
- Continuous 24-hour electrocardiographic monitoring revealed significant sinus bradycardia, sinoatrial block, and sinus arrest.
- Two patients exhibited associated atrioventricular block, suggesting potential binodal disease.
- Atrial fibrillation or flutter was present in three children.
Implications:
- Isolated SSS in children can be a life-threatening condition.
- Early recognition and continuous monitoring are vital for assessing SSS severity.
- Permanent pacemaker insertion is indicated in selected pediatric cases to prevent severe outcomes.
Abstract:
The clinical and electrocardiographic findings in five children with the sick sinus syndrome and an otherwise normal heart are described. There were three boys and two girls. Their age at onset of either bradycardia or symptoms ranged from 1 day to 7 years. In one patient, the youngest ever reported with this syndrome, bradycardia was noted before birth. Four children presented with neurological symptoms--attacks of dizziness, fainting spells, or syncope. One boy, treated for epilepsy before the underlying arrhythmia ws diagnosed, died suddenly while playing. One child had near-fatal syncope caused by ventricular tachycardia. Continuous 24-hour electrocardiographic monitoring is the best method of assessing the severity of the condition. Sinus bradycardia, sinuatrial block, and periods of sinus arrest up to 4.8 seconds were recorded. Two patients had associated atrioventricular block and were therefore presumed to have binodal disease. Atrial fibrillation or flutter occurred in three patients. Isolated sick sinus syndrome may be a life-threatening condition in childhood for which, in selected cases, the insertion of a permanent pacemaker is indicated.