Anlotinib-induced sick sinus syndrome:Two case reports

BACKGROUND This manuscript describes the first known cases of sick sinus syndrome(SSS)associated with the use of anlotinib in non-small cell lung cancer patients,highlighting the need for increased vigilance and cardiac monitoring.CASE SUMMARY Two patients with non-small cell lung cancer developed SSS after 15 months and 5 months of anlotinib treatment,respectively,presenting with syncope and palpit-ations.Electrocardiogram confirmed SSS,and different treatment approaches were taken for each patient.One patient received a dual-chamber permanent pacemaker,while the other discontinued the medication and experienced symptom resolution.CONCLUSION Anlotinib can induce SSS,suggesting that cardiac monitoring is crucial during anlotinib treatment.Individualized management strategies are necessary for affected individuals.

Headache and sick sinus syndrome:A case report

BACKGROUND Sick sinus syndrome is a common disease in cardiology.Typical symptoms include palpitations,dizziness,shortness of breath,chest tightness,and amaurosis.However,to date,there are no known reports of sick sinus syndrome presenting with headache.Whether there is a correlation between headache and sick sinus syndrome merits further research.In this report,we describe a case of headache induced by sick sinus syndrome.CASE SUMMARY A 73-year-old female patient presented to our department with the chief complaint of recurrent paroxysmal headache for more than 7 years.The patient described paroxysmal palpations,usually headache occurring after palpitation.Her blood pressure was normal when the most recent headache occurred.A magnetic resonance imaging study and magnetic resonance angiography of the head at another center were normal.A clinical neurological examination was negative.A 24-h Holter electrocardiogram monitoring study showed sick sinus syndrome.The patient received dual chamber pacing implantation and was administered drug therapy to control ventricular rate.The patient’s paroxysmal headaches and palpitations had resolved within 1 year,confirmed via a follow-up telephone call.CONCLUSION After dual-chamber pacing implantation and drug therapy administration to control the ventricular rate,the patient’s paroxysmal headaches and palpitations had resolved within 1 year,confirmed via a follow-up telephone call.We believe that the headaches were related to the patient’s sick sinus syndrome.

Efficacy and safety of Mahuang Fuzi Xixin Decoction on sick sinus syndrome： Ameta – analysis

Objective： To evaluate the efficacy and safety of Mahuang Fuzi Xixin Decoction on sick sinus syndrome andprovide evidence for clinical practice. Methods： Randomized controlled trials of all the languages of MahuangFuzi Xixin Decoction on sick sinus syndrome were collected by computer search and manual retrieval. Theretrieval time was from January 2000 to January 2017. According to the inclusion and exclusion criteria, 2reviewers independently selected and extracted data, then evaluated the quality, cross-checked the information andevaluated the quality of menthodology. Through discussion or third reviewer to help solve the divergence, RevMan5.3 software was used to perform meta analysis. Results： A total of 7 documents （n = 612） were finally enrolled,with 358 in Mahuang Fuzi Xixin Decoction group （treatment group） and 254 in control group. Meta analysisshowed that the treatment （86.9%） was more effective than the control （70.1%）, the difference was statisticallysignificant （RR = 1.25, 95% CI：（1.15-1.37）, P 〈 0.001）; the treatment （17.0%） was safer than the control （49.8%）,the difference was statistically significant （RR=0.23,95% CI：（0.06-0.93）, P =0.04）. Conclusion： The existingclinical studies suggest that Mahuang Fuzi Xixin Decoction on sick sinus syndrome is effective and safe; due to thelimited quality of the enrolled documents, the above conclusions need more high-quality randomized controlledtrials to be verified.

Sick sinus syndrome associated with hypopituitarism:a case report and literature review

Though an association between autoimmune diseases and sick sinus syndrome has been reported,there has been no report on the association of hypopituitarism and sick sinus syndrome.Herein,we provide the first case report of hypopituitarism accompanying sick sinus syndrome in a 51-year-old woman presented to our hospital with syncope due to cardiac arrest.The patient was successfully managed by pacemaker installation and hormone replacement therapy.

Compound Tongyang Fumai decoction(通阳复脉方)improves quality of life in sick sinus syndrome:a randomized controlled study

OBJECTIVE: To evaluate the efficacy of Tongyang Fumai decoction(通阳复脉方, TYFM) on the quality of life(QOL) as a complementary therapy for sick sinus syndrome(SSS). METHODS: This randomized controlled study involved 224 patients with symptomatic SSS. Patients were randomly assigned to either the TYFM group or the control group(receiving theophylline sustained-release tablets). The primary endpoints included changes in average heart rate, the longest R to R(RR) interval, and the occurrences of long RR intervals. Secondary endpoints comprised the Short Form(SF)-36 questionnaires, the Self-Rating Anxiety Scale(SAS), and the Self-Rating Depression Scale(SDS). RESULTS: TYFM significantly improved average heart rate(TYFM: 6 bpm vs control: 3 bpm, P < 0.01), shortened longest RR interval(TYFM:-0.20 s vs control:-0.0027 s, P < 0.05), and reduced numbers of long RR(TYFM:-99 vs control:-59, P < 0.01). In SF-36, TYFM enhanced physical and mental components(P < 0.01), outperforming the control group. TYFM also improved eight SF-36 dimensions significantly(P < 0.05 or P < 0.01). Regarding SAS and SDS, TYFM reduced scores significantly(P < 0.01), while SAS improved in the control group(P < 0.01), with no change in SDS. Statistically significant differences(P < 0.01) were observed in SAS and SDS between TYFM and control groups postintervention. CONCLUSIONS: TYFM emerges as a promising alternative strategy for treating SSS, demonstrating favorable therapeutic effects and significant improvements in the quality of life for patients with SSS.

Evaluation of Sick Sinus Syndrome by Holter Monitoring and Follow-up Studies

In 95 patients (55 men and 40 women .aged 20 to 84 years )with sick sinus syndrome (SSS).24-hour monitoring

A Biological Pacemaker Restored by Autologous Transplantation of Bone Marrow Mesenchymal Stem Cells

Objective：To restore cardiac autonomic pace function by autologous trans- plantation and committed differentiation of hone marrow mesenchymal stern cells, and explore the technique for the treatment of sick sinus syndrome. Methods ： Mesenchymal stern cells isolated from canine bone marrow were culture-expanded and differentiated in vitro by 5-azacytidine. The models of sick sinus syndrome in canines were established by ablating sinus node with radio-frequency technique. Differentiated mesenchymal stem cells labeled by BrdU were autologously transplanted into sinus node area through direct injection. The effects of autologous transplantation of mesenchymal stern cells on cardiac autonomic pace function in sick sinus syndrome models were evaluated by electrocardiography, pathologic and immunohistochemical staining technique. Results：There was distinct improvement on pace function of sick sinus syndrome animal models while differentiated mesenchymal stem cells were auto-transplanted into sinus node area. Mesenchymal stern cells transplanted in sinus node area were differentiated into similar sinus node cells and endothelial cells in vivo, and established gap junction with native cardiomyocytes. Conclusion ： The committed- induced mesenchymal stern cells transplanted into sinus node area can differentiate into a- nalogous sinus node cells and improve pace function in canine sick sinus syndrome models.

Hyperthyroidism and severe bradycardia:Report of three cases and review of the literature

BACKGROUND Hyperthyroidism often leads to tachycardia,but there are also sporadic reports of hyperthyroidism with severe bradycardia,such as sick sinus syndrome(SSS)and atrioventricular block.These disorders are a challenge for clinicians.CASE SUMMARY We describe three cases of hyperthyroidism with SSS and found 31 similar cases in a PubMed literature search.Through the analysis of these 34 cases,we found 21 cases of atrioventricular block and 13 cases of SSS,with 67.6%of the patients experiencing bradycardia symptoms.After drug treatment,temporary pacemaker implantation,or anti-hyperthyroidism treatment,the bradycardia of 27 patients(79.4%)was relieved,and the median recovery time was 5.5(2-8)d.Only 7 cases(20.6%)needed permanent pacemaker implantation.CONCLUSION Patients with hyperthyroidism should be aware of the risk of severe bradycardia.In most cases,drug treatment or temporary pacemaker placement is recommended for initial treatment.If the bradycardia does not improve after 1 wk,a permanent pacemaker should be implanted.

Familial amyloid cardiomyopathy masquerading as chronic Guillain-Barre syndrome： things are not always what they seem

Familial amyloid cardiomyopathy is a challenging condition that mimics many other diseases, particularly in patients with pronounced neurological presentations and unexplained or equivocal cardiac abnormalities. In this case, a 57-year-old man was admitted for outpatient cardiological evaluation of progressive right heart failure and limb paraesthesias. The patient presented with hypertension, chronic Guillain-Barre syndrome, and sick sinus syndrome. Transthoracic echocardiograms showed a thickened ventricular wall and enlarged atrium. Tissue Doppler showed a restrictive filling pattern. Transthyretin （TTR）-associated amyloidosis, which was revealed by abdominal fat-pad biopsy and DNA analysis, explained the concurrence of independent pathological features, including neuropathy and cardiac involvement. Genetic testing identified a G 〉 T mutation in exon 4 of the transthyretin （TTR） gene. This mutation resulted in the alanine-to-serine substitution at amino acid position 117. Moreover, genetic testing confirmed that the patient＇s asymptomatic son carried the same amyloidogenic TTR mutation. Given these findings, the diagnosis of familial amyloid cardiomyopathy, which was misdiagnosed as chronic Guillain-Barre syndrome, was proposed.