Sinus Arrest Pause

Sinus pause is a failure of impulse formation within the sinus node. In sinus arrest, the P-P interval has no mathematical relation to the basic sinus node discharge rate (Fig...24-24).

CLINICAL SIGNIFICANCE The same conditions that produce SA block can also produce sinus arrest, especially digoxin toxicity and aging disease of the SA node, as in sick sinus syndrome, discussed below. The combination of digoxin and carotid sinus massage is well known to be able to produce prolonged sinus arrest. Brief periods of sinus arrest may occur in healthy individuals from increased vagal tone. If sinus arrest is prolonged, AV junctional escape beats often occur.

TREATMENT

1. Treatment depends on the underlying cause, associated dysrhythmias, and whether symptoms of hypoperfusion are present.

2. If sinus arrest is symptomatic, atropine will usually increase the sinus node discharge rate.

3. Cardiac pacing is indicated for recurrent or persisent symptomatic bradycardia.

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