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.
The 10 take-home messages for the management of bradycardia
and cardiac conduction delay as per these new guidelines include:
1.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.
2.The presence of nocturnal bradycardia should prompt
consideration for sleep apnoea screening even if it is not an indication for
permanent pacing.
3. Echocardiography is the most appropriate initial screening
test for structural heart disease.
4. Temporal correlation should be established between symptoms
and bradycardia to determine if permanent pacing is needed.
5.Permanent pacing is recommended in patients with acquired
second-degree Mobitz type II atrioventricular block, high-grade atrioventricular
block or third-degree atrioventricular block.
6. In patients with an LVEF between 36 to 50%, techniques that
provide physiologic ventricular activation should be preferred over right
ventricular pacing.
7. Post-procedure surveillance after TAVR and pacemaker
implantation should be considered.
8. Shared decision-making and patient-centred care should be
the key focus in all treatment decisions.
9.Decisions should involve all stakeholders and should always
be patient-specific.
10.Patient populations that will benefit most from emerging
pacing technologies should be identified.
The new guidelines also include recommendations on
post-procedure surveillance after TAVR as well as pacemaker implantation.
Finally, the importance of shared decision-making between patients and
clinicians as well as a focus on patient-centred care are also highlighted in
the new guidelines.
“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.”
The new guidelines
are published in the Journal of the American College of Cardiology, Circulation
and Heart Rhythm.
Source: AHA/ACA/Heart Rhythm Society
