![]() However, there are still many patients for whom a pacemaker is not suitable and there is no evidence that many patients do have a reduction of mortality after implanting artificial pacemaker ( 17). Until now, artificial pacemaker implantation had been recognized as the most effective treatment for SSS, with more than 50% of surgical pacemaker implantations surgery worldwide are performed for SSS patients ( 16). It was estimated that by 2060 there will be more than 172,000 new cases of SSS in the United States each year ( 15). Approximately, 1 in 600 patients with cardiovascular disease over 65 years old was a SSS patient ( 14). The incidence of SSS has been increasing in United States since 2012, with more than 75,000 people suffering from SSS each year. SSS was most prevalent in the elderly, and its 5-year survival rate was 62−65%, and the incidence of embolism was 15% ( 13). ![]() Epidemiological studies suggested that the age of onset of SSS is between the ages of 20 and 90 with an increasing incidence with age ( 12). ![]() The DANPACE study identified the incidence, predictors and prognostic significance of syncope in 1415 patients with SSS, and after a mean follow-up of 5.4 years the results found a higher mortality rate in patients with SSS who experienced syncope ( 11). The symptoms of SSS patients were gradually aggravated from mild fatigue, insomnia, memory loss, transient vertigo and syncope, which showed a positive correlation between the degree of organ ischemia and the duration of cardiac arrest ( 10). Impaired sinus node pacing with sinus bradycardia or sinus arrest, where the heart has difficulty compensating for the slowed or stopped heart rate with a reduction in cardiac output per boom, may result in signs and symptoms of cardiac insufficiency ( 9). Other studies suggested that aging and myocardial fibrosis may be a common pathogenesis of SSS and atrial fibrillation, but the research could not account for all cases of SSS and more in-depth pathogenesis needs further research ( 8). In a human and animal models of atrial fibrillation, atrial fibrillation induced remodeling of the right and left atria (including the sinus node), leading to atrial fibrosis, impaired calcium channels, and abnormal gene expression in patients with SSS, which exacerbates sinus node dysfunction and the progression of atrial fibrillation ( 5– 7). Although SSS was closely associated with atrial fibrillation, the exact underlying pathogenesis remains unclear ( 4). Supraventricular tachycardia occurs intermittently in about 50% of patients with SSS, which is known as brady-tachy arrhythmia syndrome, a typical clinical manifestation of SSS ( 3). Manifestations of SSS mainly include sinus bradycardia, ectopic atrial bradycardia, sinus node outlet block, sinus arrest, sinus node arrest, brady-tachy arrhythmia syndrome, chronotropic insufficiency, and rhythmic separation, etc. SSS is asymptomatic or mildly symptomatic in the early stages, and some patients with SSS are detected on physical examination. SSS is usually diagnosed by the patient’s signs and symptoms examination as well as electrocardiogram examination. ![]() Sick sinus syndrome (SSS) is a group of syndromes in which the pacing and efferent functions of the sinoatrial node (SAN) are impaired due to organic changes in the SAN and its surrounding tissues, resulting in chronic arrhythmias with insufficient blood supply to the heart, brain, kidneys and other organs ( 1). In conclusion, bibliometric analysis provided valuable information for the prevention, treatment and future research trends of SSS. In the field of basic applied research and basic research, atrial fibrillation and pacemaker cells were the focus of research. Clinical studies on SSS found that sick sinus syndrome, atrial fibrillation, and pacemakers were the top three keywords that had the largest nodes and the highest frequency. Pacemaker implantation, differentiation and mutation are research hotspots currently. Sick sinus syndrome, atrial fibrillation and sinus node dysfunction were the top three keywords that had the strongest correlation with the study. ![]() SSS was closely related to risk factors such as atrial fibrillation and aging. The results showed the United States dominated the field, followed by Japan, Germany, and China. 2,251 publications related to SSS were retrieved from Web of Science database from 2000 to 2022 and analyzed by using VOS viewer and CiteSpace software. Sick sinus syndrome (SSS) is a refractory arrhythmia disease caused by the pathological changes of sinoatrial node and its adjacent tissues. ![]()
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