����Permanent pacemaker implantation may be considered in:
������ minimally symptomatic patients with chronic heart rate <40 bpm while awake.
(IIb-C)
����Permanent pacemaker implantation is NOT indicated for SND:
������ in asymptomatic patients. (III-C)
������ in patients for whom the symptoms suggestive of bradycardia have been clearly
documented to occur in the absence of bradycardia. (III-C)
������ with symptomatic bradycardia due to nonessential drug therapy. (III-C)
Figure 1. Sinus Node Dysfunction
Sinus Node Dysfunction
Evidence for impaired AV conduction or concern ���
over future development of AV block
NO
Desire for rate
response
NO
Atrial pacemaker
YES
Ventricular
pacemaker
Desire for AV
synchrony
NO
YES
Rate-responsive
atrial pacemaker
Desire for rate
response
NO
YES
YES
Rate-responsive
ventricular
pacemaker
Desire for rate
response
NO
Dual-chamber
pacemaker
YES
Rate-responsive
dual-chamber
pacemaker
1
