Sinus Node Disease in a Young Female With Cardiogenic Syncope

Sinus node dysfunction (SND) is characterized by disease of the sinus node and/or contiguous atrial tissue resulting in the generation of heart rate that is not commensurate with the physiologic need of the body due to various causes. SND is an ailment commonly found in the advanced age group, with a mean age of 68 years, and is rarely found in the young. Making a diagnosis requires the presence of symptoms to coincide with the abnormal electrocardiographic (ECG) findings, and the symptoms of SND are non-specific. There is a limited report of this condition in the young, and available reports show that most cases of SND occur in the young and children with underlying heart defects and mostly in males. The report describes an unusual presentation of ‘sinus node disease’ in a young Caucasian female with no underlying cardiac abnormalities that presented with syncope and sinus bradycardia. A 36-year-old Caucasian female presented to our facility with complaints of recurrent episodes of a brief period of loss of consciousness associated with intermittent palpitations and no background cardiovascular disease. Rest 12-lead ECG showed bradycardia, while a 24-hour Holter ECG showed periods of bradycardia, ‘supraventricular tachycardia’, and tachycardia- bradycardia occurring with symptoms. A diagnosis of SND was made and a permanent pacemaker was offered, but she and her spouse opted to have the procedure done in her home country. ‘Sinus node disease’ through an ailment of the aged can be found in the young without underlying cardiac defects and can be suspected in people with unexplained syncope.