Login Register Cart 0
Generic placeholder image

Current Cardiology Reviews

Editor-in-Chief

ISSN (Print): 1573-403X
ISSN (Online): 1875-6557

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Review Article

Evaluation and Management of Asymptomatic Bradyarrhythmias

Author(s): Göksel Çinier*, Sohaib Haseeb, Giorgos Bazoukis, Cynthia Yeung and E. Elvin Gül

Volume 17, Issue 1, 2021

Published on: 21 July, 2020

Page: [60 - 67] Pages: 8

DOI: 10.2174/1573403X16666200721154143

Price: $65

Abstract

Asymptomatic bradyarrhythmias involving sinus node dysfunction and atrioventicular blocks are frequently noted in clinical practice. Its prevalence is expected to rise as devices that are developed for monitoring cardiac rhythm for longer duration become more widely available. Episodes of bradyarrhythmia that are asymptomatic are considered to have a benign course compared with those that cause symptoms and do not necessitate further treatment. However, in certain cases, they can be a harbinger of future symptoms or cardiac manifestations of systemic diseases. The evaluation and risk stratification of individuals presenting with asymptomatic bradyarrhythmias is important not only for preventing implantation of unnecessary permanent pacing devices but also for reducing significant morbidity by implementing proper treatment as required. In this article, we will review the current evidence on the pathophysiology, diagnosis, evaluation and management of patients with asymptomatic bradyarrhythmias.

Keywords: Asymptomatic, atrioventricular block, bradyarrhythmias, cardiac pacing, sinus node dysfunction, ECG.

Graphical Abstract

[1]
Brignole M, Vardas P, Hoffman E, et al. Task Force members; EHRA Scientific Documents Committee; Document Reviewers; EHRA Scientific Documents Committee. Indications for the use of diagnostic implantable and external ECG loop recorders. Europace 2009; 11(5): 671-87.
[http://dx.doi.org/10.1093/europace/eup097] [PMID: 19401342]
[2]
Rockx MA, Hoch JS, Klein GJ, et al. Is ambulatory monitoring for “community-acquired” syncope economically attractive? A cost-effectiveness analysis of a randomized trial of external loop recorders versus Holter monitoring. Am Heart J 2005; 150(5): e1-5.
[3]
Locati ET, Moya A, Oliveira M, et al. External prolonged electrocardiogram monitoring in unexplained syncope and palpitations: Results of the SYNARR-Flash study. Europace 2016; 18(8): 1265-72.
[http://dx.doi.org/10.1093/europace/euv311] [PMID: 26519025]
[4]
Brignole M, Auricchio A, Baron-Esquivias G, et al. ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Revista española de cardiología-English Edition 2014; 67(1): 58e1-e60.
[5]
Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, et al. ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2018; 2018: 25701.
[6]
Gadler F, Valzania C, Linde C. Current use of implantable electrical devices in Sweden: Data from the Swedish pacemaker and implantable cardioverter-defibrillator registry. Europace 2015; 17(1): 69-77.
[http://dx.doi.org/10.1093/europace/euu233] [PMID: 25336667]
[7]
Kusumoto FM, Schoenfeld MH, Wilkoff BL, et al. 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm 2017; 14(12): e503-51.
[http://dx.doi.org/10.1016/j.hrthm.2017.09.001] [PMID: 28919379]
[8]
Birnie DH, Nery PB, Ha AC, Beanlands RS. Cardiac sarcoidosis. J Am Coll Cardiol 2016; 68(4): 411-21.
[http://dx.doi.org/10.1016/j.jacc.2016.03.605] [PMID: 27443438]
[9]
Besant G, Wan D, Yeung C, et al. Suspicious index in Lyme carditis: Systematic review and proposed new risk score. Clin Cardiol 2018; 41(12): 1611-6.
[http://dx.doi.org/10.1002/clc.23102] [PMID: 30350436]
[10]
Yeung C, Al-Turki M, Baranchuk A. The value of the surface ECG for the diagnosis and management of lyme carditis. Curr Cardiol Rev 2020; 17(1): 5-9.
[http://dx.doi.org/10.2174/1573403X16666200312101751]
[11]
Mehra R, Benjamin EJ, Shahar E, et al. Sleep Heart Health Study. Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med 2006; 173(8): 910-6.
[http://dx.doi.org/10.1164/rccm.200509-1442OC] [PMID: 16424443]
[12]
Hoffstein V, Mateika S. Cardiac arrhythmias, snoring, and sleep apnea. Chest 1994; 106(2): 466-71.
[http://dx.doi.org/10.1378/chest.106.2.466] [PMID: 7774322]
[13]
Ferrer MI. The sick sinus syndrome in atrial disease. JAMA 1968; 206(3): 645-6.
[http://dx.doi.org/10.1001/jama.1968.03150030101028] [PMID: 5695590]
[14]
Lown B. Electrical reversion of cardiac arrhythmias. Br Heart J 1967; 29(4): 469-89.
[http://dx.doi.org/10.1136/hrt.29.4.469] [PMID: 6029120]
[15]
Arnar DO, Mairesse GH, Boriani G, Calkins H, Chin A, Coats A, et al. Management of asymptomatic arrhythmias: A European Heart Rhythm Association (EHRA) consensus document, endorsed by the Heart Failure Association (HFA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin America Heart Rhythm Society (LAHRS). EP Europace 2019.
[16]
Kaplan BM, Langendorf R, Lev M, Pick A. Tachycardia-bradycardia syndrome (so-called “sick sinus syndrome”). Pathology, mechanisms and treatment. Am J Cardiol 1973; 31(4): 497-508.
[http://dx.doi.org/10.1016/0002-9149(73)90302-0] [PMID: 4692587]
[17]
Thery C, Gosselin B, Lekieffre J, Warembourg H. Pathology of sinoatrial node. Correlations with electrocardiographic findings in 111 patients. Am Heart J 1977; 93(6): 735-40.
[http://dx.doi.org/10.1016/S0002-8703(77)80070-7] [PMID: 871100]
[18]
Csepe TA, Kalyanasundaram A, Hansen BJ, Zhao J, Fedorov VV. Fibrosis: A structural modulator of sinoatrial node physiology and dysfunction. Front Physiol 2015; 6: 37.
[http://dx.doi.org/10.3389/fphys.2015.00037] [PMID: 25729366]
[19]
Tellez JO, Mczewski M, Yanni J, et al. Ageing-dependent remodelling of ion channel and Ca2+ clock genes underlying sino-atrial node pacemaking. Exp Physiol 2011; 96(11): 1163-78.
[http://dx.doi.org/10.1113/expphysiol.2011.057752] [PMID: 21724736]
[20]
Goette A, Kalman JM, Aguinaga L, et al. Document Reviewers. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: Definition, characterization, and clinical implication. Europace 2016; 18(10): 1455-90.
[http://dx.doi.org/10.1093/europace/euw161] [PMID: 27402624]
[21]
Monfredi O, Dobrzynski H, Mondal T, Boyett MR, Morris GM. The anatomy and physiology of the sinoatrial node--a contemporary review. Pacing Clin Electrophysiol 2010; 33(11): 1392-406.
[http://dx.doi.org/10.1111/j.1540-8159.2010.02838.x] [PMID: 20946278]
[22]
Hatle L, Bathen J, Rokseth R. Sinoatrial disease in acute myocardial infarction. Long-term prognosis. Br Heart J 1976; 38(4): 410-4.
[http://dx.doi.org/10.1136/hrt.38.4.410] [PMID: 1267985]
[23]
D’Souza A, Sharma S, Boyett MR. CrossTalk opposing view: Bradycardia in the trained athlete is attributable to a downregulation of a pacemaker channel in the sinus node. J Physiol 2015; 593(8): 1749-51.
[http://dx.doi.org/10.1113/jphysiol.2014.284356] [PMID: 25871551]
[24]
Franchi F, Padeletti L, Brat A, Michelucci A, Arcangeli C, Fantini F. Assessment of sinus node function in asymptomatic subjects with sinus bradycardia and in symptomatic patients with sino-atrial disease. Acta Cardiol 1979; 34(6): 385-99.
[PMID: 317407]
[25]
Tresch DD, Fleg JL. Unexplained sinus bradycardia: clinical significance and long-term prognosis in apparently healthy persons older than 40 years. Am J Cardiol 1986; 58(10): 1009-13.
[http://dx.doi.org/10.1016/S0002-9149(86)80029-7] [PMID: 3490781]
[26]
Dharod A, Soliman EZ, Dawood F, et al. MESA Investigators. Association of asymptomatic bradycardia with incident cardiovascular disease and mortality: The Multi-Ethnic Study of Atherosclerosis (MESA). JAMA Intern Med 2016; 176(2): 219-27.
[http://dx.doi.org/10.1001/jamainternmed.2015.7655] [PMID: 26785103]
[27]
Goldberger JJ, Johnson NP, Gidea C. Significance of asymptomatic bradycardia for subsequent pacemaker implantation and mortality in patients >60 years of age. Am J Cardiol 2011; 108(6): 857-61.
[http://dx.doi.org/10.1016/j.amjcard.2011.04.035] [PMID: 21757182]
[28]
Senturk T, Xu H, Puppala K, et al. Cardiac pauses in competitive athletes: A systematic review examining the basis of current practice recommendations. Europace 2016; 18(12): 1873-9.
[PMID: 26590379]
[29]
Hilgard J, Ezri MD, Denes P. Significance of ventricular pauses of three seconds or more detected on twenty-four-hour Holter recordings. Am J Cardiol 1985; 55(8): 1005-8.
[http://dx.doi.org/10.1016/0002-9149(85)90735-0] [PMID: 3984858]
[30]
Moya A, Brignole M, Sutton R, et al. International Study on Syncope of Uncertain Etiology 2 (ISSUE 2) Group. Reproducibility of electrocardiographic findings in patients with suspected reflex neurally-mediated syncope. Am J Cardiol 2008; 102(11): 1518-23.
[http://dx.doi.org/10.1016/j.amjcard.2008.07.043] [PMID: 19026307]
[31]
Brignole M, Sutton R, Wieling W, et al. Analysis of rhythm variation during spontaneous cardioinhibitory neurally-mediated syncope. Implications for RDR pacing optimization: an ISSUE 2 substudy. Europace 2007; 9(5): 305-11.
[http://dx.doi.org/10.1093/europace/eum017] [PMID: 17400603]
[32]
Brignole M, Menozzi C, Moya A, et al. International Study on Syncope of Uncertain Etiology 3 (ISSUE-3) Investigators. Pacemaker therapy in patients with neurally mediated syncope and documented asystole: Third International Study on Syncope of Uncertain Etiology (ISSUE-3): A randomized trial. Circulation 2012; 125(21): 2566-71.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.111.082313] [PMID: 22565936]
[33]
Koehler U, Fus E, Grimm W, et al. Heart block in patients with obstructive sleep apnoea: Pathogenetic factors and effects of treatment. Eur Respir J 1998; 11(2): 434-9.
[http://dx.doi.org/10.1183/09031936.98.11020434] [PMID: 9551750]
[34]
Vogler J, Breithardt G, Eckardt L. Bradyarrhythmias and conduction blocks. Rev Esp Cardiol (Engl Ed) 2012; 65(7): 656-67.
[http://dx.doi.org/10.1016/j.rec.2012.01.027] [PMID: 22627074]
[35]
Surawicz B, Uhley H, Borun R, et al. Task Force I: standardization of terminology and interpretation. Am J Cardiol 1978; 41(1): 130-45.
[http://dx.doi.org/10.1016/0002-9149(78)90147-9] [PMID: 622995]
[36]
Baruteau A-E, Pass RH, Thambo J-B, et al. Congenital and childhood atrioventricular blocks: Pathophysiology and contemporary management. Eur J Pediatr 2016; 175(9): 1235-48.
[http://dx.doi.org/10.1007/s00431-016-2748-0] [PMID: 27351174]
[37]
Yeung C, Baranchuk A. Diagnosis and treatment of lyme carditis: JACC review topic of the week. J Am Coll Cardiol 2019; 73(6): 717-26.
[http://dx.doi.org/10.1016/j.jacc.2018.11.035] [PMID: 30765038]
[38]
Brady WJ Jr, Harrigan RA. Diagnosis and management of bradycardia and atrioventricular block associated with acute coronary ischemia. Emerg Med Clin North Am 2001; 19(2): 371-384, xi-xii.
[http://dx.doi.org/10.1016/S0733-8627(05)70189-9] [PMID: 11373984]
[39]
Barold SS. Indications for permanent cardiac pacing in first-degree AV block: Class I, II, or III? Pacing Clin Electrophysiol 1996; 19(5): 747-51.
[http://dx.doi.org/10.1111/j.1540-8159.1996.tb03355.x] [PMID: 8734740]
[40]
Carroz P, Delay D, Girod G. Pseudo-pacemaker syndrome in a young woman with first-degree atrio-ventricular block. Europace 2010; 12(4): 594-6.
[http://dx.doi.org/10.1093/europace/eup373] [PMID: 19946114]
[41]
Coumbe AG, Naksuk N, Newell MC, Somasundaram PE, Benditt DG, Adabag S. Long-term follow-up of older patients with Mobitz type I second degree atrioventricular block. Heart 2013; 99(5): 334-8.
[http://dx.doi.org/10.1136/heartjnl-2012-302770] [PMID: 23086974]
[42]
Shaw DB, Gowers JI, Kekwick CA, New KH, Whistance AW. Is Mobitz type I atrioventricular block benign in adults? Heart 2004; 90(2): 169-74.
[http://dx.doi.org/10.1136/hrt.2003.017806] [PMID: 14729789]
[43]
Bordachar P, Zachary W, Ploux S, Labrousse L, Haissaguerre M, Thambo J-B. Pathophysiology, clinical course, and management of congenital complete atrioventricular block. Heart Rhythm 2013; 10(5): 760-6.
[http://dx.doi.org/10.1016/j.hrthm.2012.12.030] [PMID: 23276818]

Rights & Permissions Print Cite
Article Metrics
48
1
© 2024 Bentham Science Publishers | Privacy Policy