![]() ![]() ![]() Not all patients with congenital heart block require pacing, especially if they are asymptomatic. Ambulatory ECG monitoring or EPS may be considered for patients with a pre-existing conduction abnormality who develop prolongation of QRS or PR >20 ms. AV junction ablation should be added in the case of incomplete biventricular pacing (150 ms or PR >240 ms with no further prolongation during >48 hours after TAVI. CRT should be considered for patients with HF and LVEF ≤35% in NYHA class III or IV if they are in atrial fibrillation (AF) and have intrinsic QRS ≥130 ms, provided a strategy to ensure biventricular capture is in place. CRT should be considered for patients with HF in sinus rhythm with LVEF ≤35%, QRS duration ≥150 ms, and non-LBBB QRS morphology. CRT should be considered for symptomatic patients with HF in sinus rhythm with LVEF ≤35%, QRS duration 130-149 ms, and LBBB QRS morphology. Multimodality imaging (cardiac magnetic resonance, computed tomography, or positron emission tomography) should be considered in search of the underlying myocardial disease, particularly in patients with conduction system disease who are 40 years, with severe, unpredictable, recurrent syncope who have: 1) spontaneous documented symptomatic asystolic pause(s) >3 seconds or asymptomatic pause(s) >6 seconds due to sinus arrest or AV block or 2) cardioinhibitory carotid sinus syndrome or 3) asystolic syncope during tilt testing.ĬRT is recommended for symptomatic patients with heart failure (HF) in sinus rhythm with LV ejection fraction (LVEF) ≤35%, QRS duration ≥150 ms, and left bundle branch block (LBBB) QRS morphology. In patients with infrequent unexplained syncope, in whom a comprehensive evaluation did not demonstrate a cause, long-term ambulatory monitoring with an implantable loop recorder is recommended. Screening for sleep apnea syndrome is recommended in patients with symptoms of sleep apnea syndrome and in the presence of severe bradycardia or advanced atrioventricular (AV) block during sleep. Exercise testing is recommended in patients who experience symptoms suspicious of bradycardia during or immediately after exertion. In patients with suspected or documented symptomatic bradycardia, the use of cardiac imaging is recommended to evaluate the presence of structural heart disease, to determine left ventricular (LV) systolic function, and to diagnose potential reversible causes of conduction disturbances. The following are key points to remember from the European Society of Cardiology (ESC) and the European Heart Rhythm Association (EHRA) about the 2021 Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy (CRT):Ī careful history and physical examination are essential for the evaluation of patients with suspected or documented bradycardia. ![]()
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