Sinus Node Blocks Diagnostic

SINUS NODE
DYSFUNCTIONS
Presented by-
Барвал пиюш дилип and Абхишек
Радж
University- PERM STATE MEDICAL UNIVERSITY

CRITERIA FOR NORMAL SINUS
RHYTHM
• A P wave morphology P wave (atrial contraction) precedes every QRS complex
• The rhythm is regular, but varies slightly during respirations
• The rate ranges between 60 and 100 beats per minute
• The P waves maximum height at 2.5 mm in II and/or III
• The P wave is positive in I and II, and biphasic in V1
• If any of the above mentioned criterias are not mentioned it may be condition of
SICK SINUS NODE
NORMAL
SINUS
WAVE
PATTERN
WHAT IS A SINUS NODE?
• The sinoatrial or sinus node (SAN) is the

heart’s natural pacemaker.
• Located in the superior right atrium, it
automatically produces cyclical
electrical activity to initiate each
heartbeat in normal
sinus rhythm.
WHAT IS SINUS NODE
DYSFUNCTION?
• SAN dysfunction (SND) in humans, also known

as ‘sick sinus syndrome’, can manifest as
pathological bradycardia and asystolic
pauses.
CAUSES OF SINUS NODE
DYSFUNCTIONS-
• Sinus node dysfunction (with
accompanying symptoms)
• Sinus bradycardia: Sinus rate <50 bpm
• Ectopic atrial bradycardia: Atrial depolarization
attributable to an atrial pacemaker other than the sinus
node with a rate <50 bpm
• Sinoatrial exit block: Evidence that blocked conduction
between the sinus node and adjacent atrial tissue is
present. Multiple
• electrocardiographic manifestations including “group
beating” of atrial depolarization and sinus pauses.
• Sinus pause: Sinus node depolarizes >3 s after the last
atrial depolarization
• Sinus node arrest: No evidence of sinus node
depolarization
• Tachycardia-bradycardia (“tachy-brlady”) syndrome:
Sinus bradycardia, ectopic atrial bradycardia, or
sinus pause alternating with periods of abnormal
atrial tachycardia, atrial flutter.
• The tachycardia may be associated with suppression
of sinus node automaticity and a sinus pause of
variable duration when the tachycardia terminates.
• Chronotropic incompetence: Broadly defined as the
inability of the heart to increase its rate commensurate
with increased activity or demand, in many studies
translates to failure to attain 80% of expected heart rate
reserve during exercise.
• Isorhythmic dissociation: Atrial depolarization (from either
the sinus node or ectopic atrial site) is slower than
SICK SINUS SYNDROME THERE IS
A MALFUNCTIONING SINUS
NODE.
Several arrhythmias can result from this:
1)Symptomatic slow Sinus Bradycardia in the absence of medication
2)Sinus Arrest or exit block
3)Combinations of sinoatrial and atrioventricular conductions disturbances
4)Brady-tachycardia syndrome; typically there is sinusbradycardia, sinusarrest

or SA-block which is alternated by periods with fast or (ir)regular atrial
arrhythmias (atrial fibrillation, atrial flutter, atrial
tachyardia or sinustachycardia).
TWO MAIN VARIETY OF ECG OBSERVED
IN CASE OF SINUS NODE DYSFUNCTIONS
ABSENCE OF SINUS ACTIVITY RESULTS
INTO PAUSE BETWEEN (T AND
P
WAVES)
P WAVE PRESENT BUT THERE IS A LONG PAUSE
BETWEEN TWO (PQRST) COMPLEX
PATIENT WITH A SINUS BLOCK
SINUS ARREST
Sinoatrial arrest is a medical condition wherein

the sinoatrial node of the heart transiently ceases to generate the
electrical impulses that normally stimulate the myocardial tissues
to contract and thus the heart to beat. It is deﬁned as lasting from
2.0 seconds to several minutes.
THERE IS ABSENCE OF ( P WAVE )
RANDOM LONG PAUSE ARE PRESENT
IN BETWEEN THE
COMLEXES
SINUS NODE NOT FUNCTIONING
BUT ( AV NODE) STILL
WORKING
DIFFRENCE BETWEEN SINUS BLOCK
AND SINUS ARREST
CARDIAC RHYTHM
MONITORS
NONPHYSICIAN PRESCRIBED
SMARTPHONE BASED
SYSTEMS
NONPHYSICIAN PRESCRIBED
SMARTPHONE BASED SYSTEMS
COMMERCIALLY AVAILABLE SMARTPHONE–BASED
SYSTEMS
CAN RECORD A RHYTHM STRIP WHEN THE PATIENT HAS

SYMPTOMS OR CONTINUOUSLY
DEPENDING ON THE TECHNOLOGY
HOLTER. MONITOR
HOLTER MONITOR
IT IS A SMALL, BATTERY-POWERED MEDICAL DEVICE THAT
MEASURES YOUR HEART'S ACTIVITY, SUCH AS RATE AND RHYTHM.
YOUR DOCTOR MAY ASK YOU TO USE ONE IF THEY NEED MORE
INFORMATION ABOUT HOW YOUR HEART FUNCTIONS THAN A
ROUTINE ELECTROCARDIOGRAM (EKG) CAN GIVE THEM.
HOLTER MONITOR
CONTINUOUS RECORDING FOR 24–72 H;

UP TO 2 WK WITH NEWER MODELS
SYMPTOM RHYTHM CORRELATION CAN BE ACHIEVED

THROUGH A PATIENT EVENT DIARY
AND PATIENT-ACTIVATED ANNOTATIONS
PRIMARILY
USED TO
EVALUATE
THE
PACEMAKER
FUNCTIONS
PATIENT-ACTIVATED,
TRANSTELEPHONIC MONITOR
(EVENT MONITOR)
A RECORDING DEVICE THAT TRANSMITS

PATIENT-ACTIVATED DATA (LIVE OR STORED)
VIA AN ANALOG TELEPHONE LINE TO A
CENTRAL REMOTE MONITORING STATION
(EG,
PHYSICIAN OFFICE)
EXTERNAL LOOP RECORDED
(PATIENT OR AUTO
TRIGGERED)*
EXTERNAL LOOP RECORDED
(PATIENT OR AUTO TRIGGERED)*
A DEVICE THAT CONTINUOUSLY RECORDS AND

STORES RHYTHM DATA OVER WEEKS TO MONTHS
PATIENT ACTIVATED, OR AUTO TRIGGERED (EG, TO
RECORD ASYMPTOMATIC ARRHYTHMIAS) TO PROVIDE
A RECORDING OF EVENTS ANTECEDENT TO (3–14 MIN),
DURING, AND AFTER (1–4 MIN) THE TRIGGERED EVENT
NEWER MODELS ARE EQUIPPED WITH A CELLULAR
TELEPHONE, WHICH TRANSMITS TRIGGERED DATA
AUTOMATICALLY OVER A WIRELESS NETWORK TO A
REMOTE MONITORING SYSTEM
EXTERNAL PATCH RECORDERS
PATCH DEVICE
EXTERNAL PATCH RECORDERS PATCH
DEVICE THAT CONTINUOUSLY RECORDS AND STORES RHYTHM DATA, WITH
PATIENT-TRIGGER CAPABILITY TO ALLOW FOR SYMPTOM-RHYTHM
CORRELATION
NO LEADS OR WIRES, AND ADHESIVE TO CHEST
WALL/STERNUM VARIOUS MODELS RECORD FROM 2–14 D
OFFERS ACCURATE MEANS OF ASSESSING BURDEN OF AF
PATIENT ACTIVATED, OR AUTO TRIGGERED (EG, TO RECORD

ASYMPTOMATIC ARRHYTHMIAS) TO PROVIDE A
RECORDING OF EVENTS
ANTECEDENT TO, DURING, AND AFTER THE TRIGGERED
EVENT
MOBILE CARDIAC
OUTPATIENT
TELEMETRY
MOBILE CARDIAC
OUTPATIENT TELEMETRY
DEVICE THAT RECORDS AND TRANSMITS DATA (UP TO 30 D) FROM
PREPROGRAMMED ARRHYTHMIAS OR PATIENT ACTIVATION TO A
COMMUNICATION HUB AT THE PATIENT’S HOME
SIGNIFICANT ARRHYTHMIAS ARE DETECTED;
THE MONITOR AUTOMATICALLY TRANSMITS THE PATIENT’S

ELECTROCARDIOGRAPHIC DATA THROUGH A WIRELESS NETWORK TO THE
CENTRAL MONITORING STATION, WHICH IS ATTENDED BY TRAINED
TECHNICIANS 24 H/D
IMPLANTABLE
CARDIAC
MONITOR
CARDIAC MONITOR
IMPLANTABLE INTO THE
CHEST
WALL
IMPLANTABLE CARDIAC
MONITOR
SUBCUTANEOUSLY IMPLANTED DEVICE, WITH A BATTERY LIFE OF 2–3 Y
TRIGGERED BY THE PATIENT (OR OFTEN FAMILY MEMBER WITNESS) TO

STORE THE EVENTMODELS ALLOW FOR TRANSTELEPHONIC
TRANSMISSION, AS WELL AS AUTOMATIC DETECTION OF
SIGNIFICANT ARRHYTHMIAS WITH REMOTE MONITORING
LEADLESS PACEMAKER
LEADLESS PACEMAKER
• It does not have any leads or wires.

• It is with catheter procedure it is implanted in the heart
It can work upto 10 years and it functions on its own.
SINGLE LEAD PACEMAKER
• It is for lower chambers of heart
DOUBLE LEAD PACEMAKER
ONE LEAD GOES TO UPPER CHAMBER ANDOTHER
ONE TO THE LOWER CHAMBER
THREE LEAD PACEMAKER
THREE LEAD PACEMAKER
• It has three leads for the sinus node , second for
the atriventricular node and third for the
conductive fibers of ventricles.
CONCLUSION
• Fibrosis, cell loss and coronary artery disease are often quoted as the
main causes of SND. However it is clear that SND is not just one entity,
and is rather the phenotype of many different disease processes.
• After over 100 years of studying the SAN and its disease we are still
uncovering new insights into pacemaker function.
• Ion channel remodelling is now thought to be a major contributor

to SND and the pattern of remodelling in different diseases can be
wide and complex.
• A more complete understanding of the pathophysiology of SND will

help us find ways to manipulate novel mechanisms in the search of
alternative therapeutic options to the electronic pacemaker.
THANK YOU
FOR YOUR ATTENTION

Sinus Node Blocks Diagnostic

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SINUS NODE

University- PERM STATE MEDICAL UNIVERSITY

• The rhythm is regular, but varies slightly during respirations

• The rate ranges between 60 and 100 beats per minute

• The P waves maximum height at 2.5 mm in II and/or III

• The P wave is positive in I and II, and biphasic in V1

• The sinoatrial or sinus node (SAN) is the

• SAN dysfunction (SND) in humans, also known

1)Symptomatic slow Sinus Bradycardia in the absence of medication

2)Sinus Arrest or exit block

3)Combinations of sinoatrial and atrioventricular conductions disturbances

4)Brady-tachycardia syndrome; typically there is sinusbradycardia, sinusarrest

Sinoatrial arrest is a medical condition wherein

CAN RECORD A RHYTHM STRIP WHEN THE PATIENT HAS

CONTINUOUS RECORDING FOR 24–72 H;

SYMPTOM RHYTHM CORRELATION CAN BE ACHIEVED

A RECORDING DEVICE THAT TRANSMITS

A DEVICE THAT CONTINUOUSLY RECORDS AND

NO LEADS OR WIRES, AND ADHESIVE TO CHEST

WALL/STERNUM VARIOUS MODELS RECORD FROM 2–14 D

OFFERS ACCURATE MEANS OF ASSESSING BURDEN OF AF

PATIENT ACTIVATED, OR AUTO TRIGGERED (EG, TO RECORD

THE MONITOR AUTOMATICALLY TRANSMITS THE PATIENT’S

TRIGGERED BY THE PATIENT (OR OFTEN FAMILY MEMBER WITNESS) TO

• It does not have any leads or wires.

• Ion channel remodelling is now thought to be a major contributor

• A more complete understanding of the pathophysiology of SND will

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