How would you decide between conservative management vs. ILR or pacemaker for asymptomatic nocturnal bradycardia/pauses (as an example rates in the 30s, pauses ranging 4-12 seconds) in the absence of bradyarrhythmias during the day and ECG with normal intervals, and not otherwise on medications to slow down HR?

For additional context, work up with TTE and exercise stress testing have all been reassuring and normal.

Answer from: at Community Practice

The guidelines are clear in stating that patients with symptomatic bradycardia or higher degree heart block during waking hours would benefit from pacing, but determining symptom-rhythm correlation is not always easy. In sinus node dysfunction, there is no established minimal HR or length of pause t...

Answer from: at Academic Institution

I agree with @Knotts' excellent and comprehensive commentary. My practice is consistent with his recommendations for this scenario - i.e., no indication for a pacemaker at this time pending additional work-up but especially a sleep study to r/o OSA.

Comments

at The George Washington University Hospital
If I had 10-second pauses during sleep, I would wa...

at Optum
This raises a great question of what duration of p...

at Baylor College of Medicine/ Texas Children's Hospital
I'm with @Robert J. Knotts (his responses are spot...

at Hospital of the University of Pennsylvania
Appreciate Dr. @Lam's well-thought-out commentary ...

at Optum
Agree with @Wilson W. Lam’s insightful addit...

at Washington University School of Medicine
Agree with above comments. This patient absolutely...

at Corporacion Del Centro Cardiovascular De Puerto Rico Del
I’ll add a stress test to check for chronotr...

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