The American College of Cardiology, the American Heart Association, and the Heart Rhythm Society have just released new guidelines for the evaluation and treatment of patients with bradycardia and cardiac conduction disorders.
Bradycardia, defined as a heart rate of less than 50 beats a minute, can limit the amount of blood and oxygen that is pumped into our organs. Cardiac conduction disorders occur when electrical impulses in the heart are delayed resulting in a slow heartbeat.
The 10 take-home messages for the management of bradycardia and cardiac conduction delay as per these new guidelines include:
- Sinus node
dysfunction is related to age-dependent progressive fibrosis of the sinus nodal
tissue, and any abnormalities of the sinus node will result in bradycardia.
- The presence of
nocturnal bradycardia should prompt consideration for sleep apnoea screening
even if it is not an indication for permanent pacing.
- Echocardiography is
the most appropriate initial screening test for structural heart disease.
correlation should be established between symptoms and bradycardia to determine
if permanent pacing is needed.
- Permanent pacing is
recommended in patients with acquired second-degree Mobitz type II
atrioventricular block, high-grade atrioventricular block or third-degree
- In patients with an
LVEF between 36 to 50%, techniques that provide physiologic ventricular
activation should be preferred over right ventricular pacing.
surveillance after TAVR and pacemaker implantation should be considered.
decision-making and patient-centred care should be the key focus in all
- Decisions should
involve all stakeholders and should always be patient-specific.
- Patient populations that will benefit most from emerging pacing technologies should be identified.
“Treatment decisions are based not only on the best available evidence but also on the patient’s goals of care and preferences,” said Fred M. Kusumoto, MD, cardiologist at Mayo Clinic Florida in Jacksonville and chair of the writing committee. “Patients should be referred to trusted material to aid in their understanding and awareness of the consequences and risks of any proposed action.”
Source: AHA/ACA/Heart Rhythm Society
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