Sick sinus syndrome natural history progress over decades. Patients are usually asymptomatic at first, but then symptoms may present due to the insufficient blood supply. Sinus pause or severe bradycardia may present with the central nervous system (CNS) under perfusion which manifests with presyncope or syncope. Possible complications of sick sinus syndrome include cerebrovascular events, stroke, transient ischemic events, renal, gastrointestinal hypo-perfusion, thromboembolism, Fatigue and exercise intolerance. The syndrome is progressive, which means it usually gets worse over time.

• Sick sinus syndrome natural history progress over decades.^[1]
• Patients are usually asymptomatic at first, but then symptoms may present due to the insufficient blood supply.
• Sinus pause or severe bradycardia may present with the central nervous system (CNS) under perfusion which manifests with presyncope or syncope.

Possible complications of sick sinus syndrome include:^[2]

• Cerebrovascular events, stroke, transient ischemic events
• Renal hypoperfusion may result in oliguria.
• Gastrointestinal hypoperfusion which may present with abdominal pain.
• Thromboembolism
• Fatigue and exercise intolerance

• The syndrome is progressive, which means it usually gets worse over time.^[3]
• The long-term outlook is excellent for people who have a permanent pacemaker implanted.
• The long-term progression of SSS is mostly related to the presence and severity of associated coronary or hypertensive cardiac disease.