• Ulrich Lotze, Brigitte Rothhagen, Katharina Neubauer, and Irmhild Mäder.
• Department of Internal Medicine, Saale-Unstrut-Klinikum Naumburg, Naumburg, Germany. ulrich.lotze@klinikum-burgenlandkreis.de
• Herz. 2008 Sep 1;33(6):455-9.

BackgroundThe 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.Case StudyThe 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.ConclusionOn 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.

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