Sinus node dysfunction

One or more abnormal findings on several noninvasive or invasive tests is sufficient for the diagnosis of sinus node dysfunction in children. Invasive testing is seldom required. Presentation of the patient with sinus node dysfunction is variable and depends on patient age, presence of underlying hemodynamic disease, presence and severity of associated underlying conduction stystem disease, as well as the follow-up and monitoring practices of physicians. Dizziness/syncope and excessive fatigue or exercise intolerance, the most common symptoms of sinus node dysfunction, are difficult to document. Most patients with sinus node dysfunction are asymptomatic. Multiple causes of sinus node dysfunction have been reported in children, but most patients have a history of previous cardiac operations associated with atrial surgery. Although it is straightforward to recommend treatment (pacemaker implantation) for symptomatic patients for whom sinus node dysfunction has been documented, determination of treatment recommendations is challenging when documentation is equivocal or only mild sinus node dysfunction is found.