Algorithm for treatment of patients with sick sinus syndrome

ECG: electrocardiogram; BP: blood pressure; IV: intravenous; PPM: permanent pacemaker; SSS: sick sinus syndrome.
* The initial dose of atropine is 0.5 mg IV push. This dose may be repeated every three to five minutes to a total dose of 3 mg.
¶ While transcutaneous pacing may be initially successful in stabilizing the patient, it may not be consistently reliable and is frequently uncomfortable for the patient. Prepare for urgent transvenous pacing (if required) and obtain central venous access (preferably right internal jugular vein access).
Δ Dopamine IV infusion typically begins at a dose of 2 mcg/kg/minute and can be titrated up to 20 mcg/kg/minute if needed for heart rate and blood pressure augmentation.
◊ Epinephrine IV infusion typically begins at a dose of 2 mcg/minute and can be titrated up to 20 mcg/minute if needed for heart rate and blood pressure augmentation.
§ Isoproterenol IV infusion typically begins at a dose of 2 mcg/minute and can be titrated up to 10 mcg/minute if needed for heart rate and blood pressure augmentation.
¥ Reversible causes of SSS may include drugs (eg, beta blockers, calcium channel blockers, digoxin), ischemia, and autonomic imbalance.