Bradycardia & conduction disease
Also known as: AV block · heart block · pacemaker · sick sinus syndrome
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2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay
ACC/AHA/HRS · 2018
This is the dedicated US guideline for adults with bradycardia or with symptoms attributed to bradycardia and conduction system disease. It covers clinical presentation, diagnostic evaluation including the various monitoring modalities, and management including pacing indications, and it took over the pacemaker recommendations previously housed in the device-based therapy guidelines. Metadata record only.
- Released 6 November 2018 by the American College of Cardiology, American Heart Association and Heart Rhythm Society. source
- Supersedes the pacemaker recommendations of the 2008 device-based therapy guideline and its 2012 focused update. source
- Applies to adults over 18 years; it makes no specific paediatric recommendations. source
2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy
European Society of Cardiology (ESC) with EHRA · 2021
Europe addresses bradycardia and conduction disease chiefly through its cardiac pacing guideline rather than a separate bradycardia document. The 2021 ESC pacing guideline, developed with the European Heart Rhythm Association, covers evaluation and pacing indications across bradyarrhythmias and conduction disorders, including conduction system pacing, pacing after syncope and after transcatheter aortic valve implantation, device follow-up and remote monitoring. Metadata record only.
- Published in the European Heart Journal in 2021 by the ESC with special contribution from EHRA. source
- Covers conduction system pacing approaches including His-bundle and left bundle branch pacing alongside conventional pacing and CRT. source
- Includes pacing after syncope and after transcatheter aortic valve implantation, plus device follow-up, remote monitoring and shared decision-making. source
US vs EU key differences
- Scope differs: the European document is a combined cardiac pacing and cardiac resynchronisation therapy guideline, whereas the US document is framed narrowly around bradycardia and cardiac conduction delay. source
- Conduction system pacing appears in the European text but not the US one: the 2021 ESC guideline discusses His-bundle pacing and flags its likely growing role pending randomised trials, a topic the 2018 US bradycardia guideline predates and does not address. source
- The 2021 ESC guideline carries detailed post-TAVI conduction guidance — permanent pacing for intraprocedural AV block persisting 24 to 48 hours, and ambulatory ECG monitoring for new left bundle branch block with QRS above 150 ms — reflecting evidence accumulated after the 2018 US document. source
- Both guidelines converge on an electrophysiology-guided approach to syncope with bifascicular block, pacing when the baseline His-ventricular interval is 70 ms or longer or block is provoked by atrial pacing or drug challenge. source
What changed recently
- EU2013 → 20212021-08-27
Superseding the 2013 ESC/EHRA pacing guideline, the 2021 version adds an entirely new section on conduction system pacing (His bundle and left bundle branch area pacing), expands and revises the CRT indications in line with the heart failure task force, and adds recommendations for preventing pacing-induced cardiomyopathy plus guidance on MRI, irradiation and remote monitoring.
source ↗curation confidence 90% - US2008 Device-Based Therapy guideline / 2012 Focused Update → 20182018-11-06
This is the first US guideline devoted specifically to bradycardia and conduction delay; it supersedes the pacemaker recommendations of the 2008 ACC/AHA/HRS device-based therapy guideline and its 2012 focused update, reorganising them around evaluation of the bradycardic patient rather than around device indications.
source ↗curation confidence 90%
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