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pacemakers in sinoatrial dysfunction
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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:
Last reviewed 01/2018
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