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263988 tn?1281954296

Criteria for SSS Diagnosis - Misdiagnosis?

Changes on Holter consistent with SSS:
- Remarkably long pauses after atrial ectopic activity like PACs, SVT and atrial fibrillation (prolonged sinus nodal recovery time)

I had ONE six second lag in my heart beat as it was converting from atrial fibrillation to sinus rhythm. I was on the prescribed meds (since decided by doctor it was too much medication) when it occurred and a 7 day zio monitor.
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I had an electrophysiologist just diagnose me with SSS based on the above incident which were caused by the prescribed medicine for PAF.

Through research I discovered three classes used for diagnosing and treating SSS or tachy brady syndrome with a pacemaker.
I.  Class I:
1. a. Documented symptomatic bradycardia. [My bradycardia has been lifelong and without symptoms.]
b. FREQUENT sinus pauses. [I suffered ONE sinus pause after too much medication which was prescribed by the doctor.]
2. Symptomatic chronotropic incompetence, which the inability for the heart to increase its rate with activity or demand. [Mine heart compensates.] [Not me.]

II. Class IIa:
1. SSS occurring spontaneously or as result of necessary drug therapy, with HR less than 40 bpm where symptomatic bradycardia has not been documented. [Not me.]

III. Class IIb:
1. In minimally symptomatic patients, chronic HR less than 30 bpm while awake. [Not me.]

IV. Class III:
1. SSS in asymptomatic patients, those with substantial sinus bradycardia (HR less than 40 bpm) is a consequence of long term treatment [Not me.]
2. SSS in patients symptoms suggestive of bradycardia that are clearly documented as not associated with a slow heart rate. [Not me.]
3. SSS with symptomatic bradycardia caused by nonessential drug therapy. [Not me.]
__________

I do not fit any of these criteria and yet my doctor just diagnosed me with SSS and needing to have a pacemaker. I met this doctor for the first time on 13 May 2013.

My symptoms started when I remembered the abuse my father perpetrated on others and myself. He was a serial killer and a pedophile and forced me to watch him commit criminal acts. When the memories came back, I started having PAF episodes every time a memory surfaced.

Before the PAF, I had borderline bradycardia for years and bradycardia for years before that. My resting HR used to be 42. Prior to the PAF it was 52 to 54 lying down and 58 to 60 sitting up. It has been that way since 2003. My bradycardia has been asymptomatic.

In 2008, I had thyrotoxicosis and was placed on metoprolol which caused my heart rate to plummet to 32. The doctor said not to ever take that med again due to my reaction to it. However, my cardiologist prescribed it for PAF to slow my racing heart with beats up to 214.

I wonder if this doctor is too gung ho about a diagnosis of SSS.
3 Responses
1124887 tn?1313754891
Hello.

I can't say if you have SSS or not. However, you mentioned that your heart rate dropped to 32 when taking metoprolol. I would think this would fit into class III, wouldn't it?

The hallmark sign of SSS is as far as I know runs of atrial fibrillation alternating with sinus rhythm/sinus bradycardia and long pauses when AF converted to sinus rhythm. Which is exactly what you're describing. It's very common to faint during the pauses.

Treatment is beta blockers or other antiarrhythmics to treat the tachycardia and/or atrial fibrillation, and a pacemaker to prevent the heart rate from dropping below 50 or 60 (depending on which heart rate you need to maintain a sufficient cardiac output). Beta blockers alone can be very dangerous and worsen the symptoms.

You're saying your AF started after your PSTD(?) diagnosis. Stress and adrenaline may easily trigger atrial fibrillation in some cases. The diagnosis of SSS is often also made by seeing the SNRT (sinus node recovery time). Usually this test is done in EP studies by stimulating the atria with an extra impulse to see how long it takes for the sinus node to start firing again. Normal is <1500 msec. But as you have PACs, this test is not necessary as the PACs are doing this job. A pause longer than 1500 msec after a PAC is abnormal and will support the diagnosis of SSS.

SSS may have internal and external causes. Your sinus node or tissue around it may have suffered damage OR you may have some sort of autonomic imbalance "slowing" and/or "speeding" the sinus node inappropriately. Regardless what cause, pacemakers are used to treat inappropriate bradycardia.
967168 tn?1477584489
I've had lifelong brady/tachycardia also; one dr did mention SSS but was did not dx me with it and instead went through almost a week of testing in the hospital to see what was going on.

Previous to that testing; I did go to one dr who gave me her "wonder drug" Toprol and told me that it would change my life and get rid of my arrhythmia's.  Instead of curing me, it sent me to the ER with a dangerous HR/BP that even counter active meds couldn't raise.  The dr's couldn't believe she knew I had bradycardia and gave me that med.

I would be leery of meds with brady/tachycardia and maybe find another doctor until someone gives you some answers that make sense.  I went through 4 EP's just to make sure before I had an ablation and took meds.  The only thing I've found that worked for me is Inderal/Propranolol - some of us just have quirky systems and what may work for one of us may not for others.

For me; some of my problems stem from injury to my body similar to yours.  The Autonomic Nervous System was damaged and they believe that may be the cause along with my heart problems they found.

Hopefully you will find a doctor who will help you and you get some answers; I know what it's like to search and the frustration over not knowing for sure.
263988 tn?1281954296
Thank you for sharing your experience with me. My experience is similar to yours.

One thing which might have damaged my heart is Perimyocarditis back in 2007. I suffered from atrial fibrillation due to the myocarditis. Though I never had any symptoms after healing from it.

My hope is that taking extra doses of magnesium and enough potassium, I can keep the heart palpitations from occurring. So far I am having success. I had one heart palp episode and the magnesium caused my heart palps to stop. It occurred in less time then when I took the prescribed medicine.

Is something wrong:
The problem with your answer with that those parameters in Class III is that my heart rate is not a steady 30 - 40 beats per minute. I experienced a dip in my heart rate to 44 bpm which lasted 6 hours. My HR dipped down to 32 bpm for a short time. Both of these times were caused by taking Metoprolol. Therefore they were drug induced. My resting heart is under 60 bpm and my heart responds normally to exercise. The rate increases and then compensates to go back to normal, as it should.
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