CHAPTER 27 Bradycardia
Bradycardia is a common clinical finding, which requires careful and thorough assessment to correctly establish the underlying diagnosis and determine the appropriate therapy. Bradycardia is often a benign condition requiring no intervention, but when it gives rise to symptoms or results from conduction abnormalities that are associated with an adverse prognosis, cardiac pacing may be required unless a reversible and remediable cause can be identified. An accurate electrocardiographic diagnosis, consideration of the clinical context, and confirmation of a temporal association with any symptoms are the essential first steps to determine the appropriate therapy.When permanent pacing is required, selection of the appropriate pacing mode and careful attention to pacemaker programming are needed to ensure an optimal clinical outcome. New insights from randomized trials have provided an evidence base to guide pacemaker mode selection and paved the way for increasingly physiological pacing, preserving whenever possible the natural sequence of cardiac activation and contraction. With an increasingly vast array of sophisticated pacemakers and pacing functions, sound clinical experience and judgement are essential to ensure the delivery of effective therapy and to minimize the risk of complications. Appropriately treated, the vast majority of patients can expect to enjoy full relief of symptoms and return to normal activity with a good quality of life and no adverse impact on life expectancy.
Chapter 28)
