Pacemakers in sinoatrial dysfunction

Permanent pacemakers have an important role in the management of sinoatrial dysfunction:

• initially a single lead in the right atrium may be sufficient - however NICE recommend that dual-chamber pacing is recommended for the management of symptomatic bradycardia due to sick sinus syndrome, atrioventricular block, or a combination of sick sinus syndrome and atrioventricular block

NICE state that (1):

• dual-chamber pacing is recommended for the management of symptomatic bradycardia due to sick sinus syndrome, atrioventricular block, or a combination of sick sinus syndrome and atrioventricular block, except:
  • in the management of sick sinus syndrome in patients in whom, after full evaluation, there is no evidence of impaired atrioventricular conduction; in this situation, single-chamber atrial pacing is appropriate
  • in the management of atrioventricular block in patients with continuous atrial fibrillation; in this situation, single-chamber ventricular pacing is appropriate
  • in the management of atrioventricular block (atrioventricular block alone, or in combination with sick sinus syndrome), when patient-specific factors, such as frailty or the presence of comorbidities, influence the balance of risks and benefits in favour of single-chamber ventricular pacing

Reference:

1. NICE (February 2005).Dual-chamber pacemakers for symptomatic bradycardia due to sick sinus syndrome and/or atrioventricular block