APIK Journal of Internal Medicine

: 2020  |  Volume : 8  |  Issue : 2  |  Page : 91-

Tachybrady syndrome

Neha S Sukhani 
 Department of Medicine, Raichur Institute of Medical Sciences, Raichur, Karnataka, India

Correspondence Address:
Dr. Neha S Sukhani
Department of Medicine, Raichur Institute of Medical Sciences,Raichur, Karnataka

How to cite this article:
Sukhani NS. Tachybrady syndrome.APIK J Int Med 2020;8:91-91

How to cite this URL:
Sukhani NS. Tachybrady syndrome. APIK J Int Med [serial online] 2020 [cited 2020 Aug 4 ];8:91-91
Available from: http://www.ajim.in/text.asp?2020/8/2/91/282850

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 Image Section

Question: A 60-year-old male admitted for fever developed breathlessness. He had undergone pacemaker implantation for syncope few years back. Details were not available. What are the electrocardiography (ECG) findings?[Figure 1], [Figure 2]{Figure 1}{Figure 2}

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 Answers of ECG Diagnosis

ECG 1. Narrow QRS irregularly irregular ECG suggestive of atrial fibrillation [Figure 1]ECG 2. Wide QRS complexes preceded by pacemaker spike. No P waves noted. Ventricular sensed, Ventricular paced, Inhibited (VVI) pacemaker with underlying sinus arrest [Figure 2].

Final diagnosis: Sick sinus syndrome (SSS) (tachybrady syndrome).


SSS or sinus node dysfunction (SND) is a disorder of sinoatrial (SA) node. It may lead to atrial bradyarrhythmias, atrial tachyarrhythmias, and sometimes, bradycardia alternating with tachycardia, often referred as tachybrady syndrome. Tachybrady syndrome results from abnormal automaticity and conduction within the atrial tissue. It affects 50% of patients with SND. These patients may have simultaneous degeneration of atrioventricular (AV) node. The annual incidence of complete AV block ranges from 0% to 4.5% with a median of 0.65%.

SND can be result of age related degeneration of sinus node, congenital disorders, drugs, metabolic disorders (hypothyroidism, hyperkalemia, hypokalemia, hypoxia, and hypothermia), infiltrative disorders (amyloidosis, sarcoidosis, hemochromatosis, collagen vascular diseases, and metastatic cancer), surgery (damage to SA node or injury to SA nodal artery), and ischemia.

Symptomatic SND requires pacemaker implantation. If AV node and other conduction systems are not affected, AAI can be implanted; however, if AV node or other conduction abnormalities are present, Dual chamber sensed, paced, dual, rate responsive (DDDR) is a better option. DDDR is preferred in SND due to the increased risk of AV block, and atrial pacing attained with dual chamber pacing may reduce the incidence of AF and risk of thromboembolism.

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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.