Dual‑chamber pacemakers for symptomatic bradycardia due to sick sinus syndrome and/or atrioventricular block

  • Technology appraisal guidance
  • TA88
  • Published: 
  • Last updated: 
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1 Recommendations

This guidance refers only to pacing for the primary indications of sick sinus syndrome and/or atrioventricular block, and does not cover more complex pacing indications.

1.1

Dual-chamber pacing is recommended for the management of symptomatic bradycardia due to sick sinus syndrome, atrioventricular block, or a combination of sick sinus syndrome and atrioventricular block, except:

  • in the management of atrioventricular block in patients with continuous atrial fibrillation; in this situation, single-chamber ventricular pacing is appropriate

  • in the management of atrioventricular block (atrioventricular block alone, or in combination with sick sinus syndrome), when patient-specific factors, such as frailty or the presence of comorbidities, influence the balance of risks and benefits in favour of single-chamber ventricular pacing.

The exception about the use of dual-chamber pacing in the management of sick sinus syndrome in patients in whom, after full evaluation, there is no evidence of impaired atrioventricular conduction has been replaced by NICE technology appraisal guidance on dual‑chamber pacemakers for symptomatic bradycardia due to sick sinus syndrome without atrioventricular block.