title: Dizziness and near syncope due to sinus bradycardia and sinoatrial block associated with obesity and daytime tiredness. A clear indication for pacemaker implantation?
abstract: BACKGROUND
  The symptomatic sick sinus syndrome presents a classic indication for the implantation of a dual-chamber pacemaker according to the current national and international guidelines. However, in cases where dizziness and near syncope due to a sinus node dysfunction are found together with clinical characteristics of a sleep apnea-hypopnea syndrome (SAHS), screening for sleep apnea would be prudent before deciding for a pacemaker.
  
  
  METHODS
  The case report presented herein describes a patient with symptomatic sinus bradycardia and second-degree SA block with a Wenckebach periodicity, in whom the primary decision to implant a pacemaker was altered in favor of treatment with nCPAP (nasal continuous positive airway pressure) because after a careful and thorough evaluation of the patient's history and symptoms, a severe mixed SAHS was diagnosed.
  
  
  CONCLUSIONS
  On diagnosing SAHS with an obstructive component in patients with symptomatic bradycardia and SA block, there is no primary need for a pacemaker, but rather for implementing treatment with nCPAP. Thus, a pacemaker should only be considered in patients with intolerance or bad compliance regarding nCPAP, or in those in whom no significant reduction of bradyarrhythmia is achieved.
authors.affiliation: Department of Internal Medicine, Saale-Unstrut-Klinikum Naumburg, Naumburg, Germany. ulrich.lotze@klinikum-burgenlandkreis.de
authors.forename: Ulrich
authors.initials: U
authors.lastname: Lotze
authors.forename: Brigitte
authors.initials: B
authors.lastname: Rothhagen
authors.forename: Katharina
authors.initials: K
authors.lastname: Neubauer
authors.forename: Irmhild
authors.initials: I
authors.lastname: Mäder
mesh_terms: D001919:Bradycardia / Q000150:complications* / Q000517:prevention & control; D045422:Continuous Positive Airway Pressure; D004244:Dizziness / Q000209:etiology* / Q000517:prevention & control; D005221:Fatigue / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000517:prevention & control; D010138:Pacemaker, Artificial; D018579:Patient Selection; D012848:Sinoatrial Block / Q000150:complications* / Q000517:prevention & control; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000517:prevention & control; D013575:Syncope / Q000209:etiology* / Q000517:prevention & control; D016896:Treatment Outcome