A 72-year-old patient with syncope is diagnosed with sick sinus syndrome. What is the definitive clinical intervention?

• A. Amiodarone
• B. Permanent pacemaker
• C. Flecainide
• D. Observation

Answer: (B)

Sick sinus syndrome often presents with symptoms from slow heart rates and pauses, such as syncope, because the SA node fails to generate a steady rhythm. The definitive treatment for symptomatic bradycardia due to this condition is a permanent pacemaker. By providing a steady heart rate and preventing pauses, the pacemaker directly addresses the underlying problem and stops the recurrent syncope.

Antiarrhythmic drugs like amiodarone or flecainide can affect conduction and may worsen bradycardia or cause new blocks, so they are not curative and are not used as the primary fix for sick sinus syndrome. Observation leaves the patient at ongoing risk of syncope and hemodynamic compromise, especially in the elderly.