ÎÎPermanent pacemaker implantation may be considered in:
• minimally symptomatic patients with chronic heart rate <40 bpm while awake.
(IIb-C)
ÎÎPermanent 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
