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Memorias del Instituto de Investigaciones en Ciencias de la Salud

versão On-line ISSN 1812-9528


ALDERETE, José F  e  CENTURION, Osmar Antonio. Current concepts about the clinical classification and electrophysiological alterations in the sinus node dysfunction. Mem. Inst. Investig. Cienc. Salud [online]. 2018, vol.16, n.2, pp.113-122. ISSN 1812-9528.

Sinus node dysfunction (SND) is often secondary to senescence of the sinus node and surrounding atrial myocardium. Patients with this disorder are frequently elderly and generally have other comorbidities. Patients with SND often seek medical attention with symptoms of lightheadedness, presyncope, syncope, and, in patients with alternating periods of bradycardia and tachycardia, palpitations and/or other symptoms associated with a rapid heart rate. Because symptoms may be variable in nature, nonspecific, and frequently transient, it may be challenging at times to establish this symptom-rhythm relationship. Typical electrocardiographic findings are one or more episodes of extreme sinus bradycardia (Rubenstein type I), or sinus pauses, arrest, and sinoatrial exit block (Rubenstein type II), or alternating bradycardia and atrial tachyarrhythmias (Rubenstein type III). Investigations based on the recording of abnormally prolonged and fractionated local atrial electrograms during sinus rhythm and their characteristic distribution in the right atrium of patients with SND have provided important knowledge about the pathological atrium electrophysiological properties. Abnormal atrial electrogram results in an irregular atrial conduction, characterized by a non-homogeneous local electrical activity, related to an anisotropic, non-uniform and delayed conduction through a pathological atrial myocardium, in which reentry arrhythmias may arise. Abnormal atrial electrograms detection in SND identifies a group of patients with increased atrial vulnerability and a significantly higher incidence of spontaneous or induced episodes of atrial fibrillation.

Palavras-chave : sinus node dysfunction; sick sinus syndrome; paroxysmal atrial fibrillation; atrial vulnerability; endocardial atrial electrograms.

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