Signs and symptoms usually appear in more advanced disease and more than 50% of patients will present with syncope or transient near-fainting spells as well as bradycardias that are accompanied by rapid heart rhythms, referred to as tachycardia-bradycardia syndrome[4][5] Other presenting signs or symptoms can include confusion, fatigue, palpitations, chest pain, shortness of breath, headache, and nausea.

Patients can also present with symptoms of congestive heart failure, stroke or transient ischemic attacks due to the abnormal rhythm.

[5][6] Sinus node dysfunction has a close association with the presence of atrial fibrillation due to their shared etiology of remodeling.

[5][6] Inherited sinus node dysfunction has been associated with mutations of the gene responsible for the formation of the alpha subunit of the sodium channel (SCN5A).

[7] Exercise stress tests can be utilized to identify intrinsic causes of sinus node dysfunction.

[5][7][8] The goal of this treatment modality is to relieve symptoms associated with sinus node dysfunction and improve quality of life.

Therefore, a dual-chamber pacemaker capable of managing atrial tachyarrhythmias as well as bradyarrhythmias is implanted before drug therapy is begun.