September 3, 2026Journal of the American College of Cardiology
2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay
Population
Patients with bradycardia and cardiac conduction delay
Design
Guideline
Authors
Discussion
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Member takes
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.”
“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.”
Overview
Directs evaluation and management of bradycardia and conduction delay; extends prior guidelines with updated evidence-based recommendations.
Key Points
- Provide comprehensive, evidence-based clinical recommendations for the diagnostic evaluation and therapeutic management of patients presenting with bradycardia or cardiac conduction delays.
- Systematic literature review and consensus development conducted by a joint task force representing the ACC, AHA, and HRS.
- Grading of clinical evidence to assign standardized Class of Recommendation (COR) and Level of Evidence (LOE) designations across diagnostic and therapeutic strategies.
- Establishes structured clinical pathways for the diagnostic evaluation of sinus node dysfunction, atrioventricular block, and fascicular conduction disease.
- Outlines precise criteria for permanent pacemaker implantation, temporary pacing, and medical management based on symptom correlation and underlying etiology.
Structured PICO
P
Population
Patients with bradycardia and cardiac conduction delay
I
Intervention
Evaluation and management strategies as per guidelines
Provides the 2018 ACC/AHA/HRS clinical practice guidelines for the evaluation and management of patients with bradycardia and cardiac conduction delay.
Cite This Study
Kusumoto et al. (2018) studied this question. The 2018 ACC/AHA/HRS clinical practice guideline establishes updated recommendations for the evaluation and management of patients with bradycardia and cardiac conduction delay.