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©2013 UpToDate ® Print Email ACC/AHA/HRS: Indications for permanent pacing in sinus node dysfunction Class I - There is evidence and/or general agreement that permanent pacing is indicated in patients with sinus node dysfunction in the following settings: • Documented symptomatic bradycardia, including frequent sinus pauses that produce symptoms. (Level of Evidence: C) • Symptomatic chronotropic incompetence. (Level of Evidence: C) • Symptomatic sinus bradycardia that results from required drug therapy for medical conditions. (Level of Evidence: C) Class IIa - The weight of evidence or opinion is in favor of the usefulness of permanent pacing in patients with sinus node dysfunction in the following settings: • Heart rate <40 beats per minute when a clear association between significant symptoms consistent with bradycardia and the actual presence of bradycardia has not been documented. (Level of Evidence: C) • Syncope of unexplained origin when clinically significant abnormalities of sinus node function are discovered or provoked in electrophysiological studies. (Level of Evidence: C) Class IIb - The evidence or opinion is less well established that permanent pacing in sinus node dysfunction is beneficial in the following setting: • Minimally symptomatic patients with chronic heart rate <40 beats per minute while awake. (Level of Evidence: C) Class III - There is evidence that permanent pacing in sinus node dysfunction is not useful and may be harmful in the following settings: • Asymptomatic patients. (Level of Evidence: C) • Patients for whom the symptoms suggestive of bradycardia have been clearly documented to occur in the absence of bradycardia. (Level of Evidence: C) • Symptomatic bradycardia due to nonessential drug therapy. (Level of Evidence: C) Adapted from Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:e350. Indications for pacing for sinus node dysfunction Pacemaker necessary Pacemaker probably necessary Pacemaker not necessary Symptomatic bradycardia

Adapted from Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:e350. Indications for pacing for sinus node dysfunction Pacemaker necessary Pacemaker probably necessary Pacemaker not necessary Symptomatic bradycardia Symptomatic patients with sinus node dsfunction withdocumented rates of <40 bpm without a clear-cut association betweensignificant symptoms and the bradycardia Asymptomatic sinus node dysfunction Symptomatic sinus bradycardia due to long-term drug therapy of a type and dose for which there is no accepted alternative

©2013 UpToDate ® Print Email ACC/AHA/HRS: Indications for permanent pacing in sinus node dysfunction Class I - There is evidence and/or general agreement that permanent pacing is indicated in patients with sinus node dysfunction in the following settings: • Documented symptomatic bradycardia, including frequent sinus pauses that produce symptoms. (Level of Evidence: C) • Symptomatic chronotropic incompetence. (Level of Evidence: C) • Symptomatic sinus bradycardia that results from required drug therapy for medical conditions. (Level of Evidence: C) Class IIa - The weight of evidence or opinion is in favor of the usefulness of permanent pacing in patients with sinus node dysfunction in the following settings: • Heart rate <40 beats per minute when a clear association between significant symptoms consistent with bradycardia and the actual presence of bradycardia has not been documented. (Level of Evidence: C) • Syncope of unexplained origin when clinically significant abnormalities of sinus node function are discovered or provoked in electrophysiological studies. (Level of Evidence: C) Class IIb - The evidence or opinion is less well established that permanent pacing in sinus node dysfunction is beneficial in the following setting: • Minimally symptomatic patients with chronic heart rate <40 beats per minute while awake. (Level of Evidence: C) Class III - There is evidence that permanent pacing in sinus node dysfunction is not useful and may be harmful in the following settings: • Asymptomatic patients. (Level of Evidence: C) • Patients for whom the symptoms suggestive of bradycardia have been clearly documented to occur in the absence of bradycardia. (Level of Evidence: C) • Symptomatic bradycardia due to nonessential drug therapy. (Level of Evidence: C) Adapted from Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:e350.