15
Management strategies Key points
• Management options discussed included
observation, loop recorder insertion,
and pacemaker implantation (leadless,
transvenous single-chamber versus dual-
chamber).
• Values elicited in discussion included
desire to avoid recurrent syncope and
injury, simplicity of treatment, and
preference for quick recovery.
• Leadless pacemaker was chosen by the
patient to provide protection against
arrhythmia recurrence and the most
likely cause of syncope and associated
injury.
• Relatively simple procedures
(pacemaker implantation) may
be associated with a higher rate of
complications or prolonged recovery in
this and similar populations.
• Dual-chamber pacemaker implantation
with atrial lead implantation for
underlying sinus node dysfunction
is unlikely to provide significant
additional benefit but may be
accompanied by a higher frequency
of procedural risks and prolonged
recovery (such as infectious and
respiratory complications, including
pneumothorax).
• Therapies targeting quality of life
remain the primary focus in patients
with advanced neuromuscular
involvement.
