January 14, 2019Circulation
2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society
Fred KusumotoMark H. SchoenfeldColetta BarrettJames R. EdgertonKenneth A. EllenbogenMichael R. GoldNora GoldschlagerRobert M. HamiltonJosé A. JoglarRobert J. KimRichard LeeJoseph E. MarineChristopher J. McLeodKeith R. OkenKristen K. PattonCara N. PellegriniKimberly A. SelzmanAnnemarie ThompsonPaul D. Varosy
Key Points
- This guideline aims to provide recommendations for the evaluation and management of bradycardia and cardiac conduction delays.
- Developed by the ACC/AHA Task Force and the Heart Rhythm Society committee
- Reviewed existing literature and performance measures
- Contributors from various specialties provided insights
- Establishes comprehensive management strategies for patients with bradycardia
- Recommends performance measures to ensure quality of care
- Highlights the importance of individualized treatment plans
PICO
P
Population
Bradycardia and Cardiac Conduction Delay
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Treatment decisions are based not only on the best available evidence but also on the patient's goals of care and preferences. Patients should be referred to trusted material to aid in their understanding and awareness of the consequences and risks of any proposed action.”
“We're the first guideline [in this area] that talks about the fact that you can remove or withdraw pacemaker therapy and that that would not be considered assisted suicide.... Including the patient and their family in all discussions about whether to implant the device or whether to withdraw therapy is really critical, because unfortunately we doctors have not been that good about that in the past.”
“Identifying patient populations who will benefit the most from emerging pacing technologies, such as His bundle pacing and transcatheter leadless pacing systems, will require further investigation as these modalities are incorporated into clinical practice. Regardless of technology, for the foreseeable future, pacing therapy requires implantation of a medical device, and future studies are warranted to focus on the long-term implications associated with lifelong therapy.”
Implication
Guidelines evaluate and manage bradycardia and conduction delays, indicating best practices for clinicians.
Abstract
August 20, 2019 e333 *Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡STS Representative. §HRS Representative. ‖PACES Representative. ¶ACC/AHA Task Force on Clinical Practice Guidelines Liaison. #AATS Representative. **Dr. Pellegrini contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the US Department of Veterans Affairs or the US government. ††ACC/AHA Performance Measures Representative. WRITING COMMITTEE MEMBERS* Fred M. Kusumoto, MD, FACC, FAHA, FHRS, Chair Mark H. Schoenfeld, MD, FACC, FAHA, FHRS, Vice Chair Coletta Barrett, RN, FAHA† James R. Edgerton, MD, FACC, FHRS‡ Kenneth A. Ellenbogen, MD, FACC, FAHA, FHRS*† Michael R. Gold, MD, PhD, FACC*§ Nora F. Goldschlager, MD, FACC, FAHA, FHRS† Robert M. Hamilton, MD‖ José A. Joglar, MD, FACC, FAHA, FHRS¶ Robert J. Kim, MD† Richard Lee, MD, MBA# Joseph E. Marine, MD, MBA, FACC, FHRS§ Christopher J. McLeod, MB, ChB, PhD, FACC, FAHA, FHRS† Keith R. Oken, MD, FACC† Kristen K. Patton, MD, FACC, FAHA, FHRS† Cara N. Pellegrini, MD, FHRS*§** Kimberly A. Selzman, MD, MPH, FACC, FHRS† Annemarie Thompson, MD† Paul D.
Discussion
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Cite This Study
Kusumoto et al. (2019) conducted a review in Bradycardia and Cardiac Conduction Delay. The 2018 ACC/AHA/HRS guidelines provide recommendations for the evaluation and management of patients with bradycardia and cardiac conduction delay.