Table 1.
Heart Rhythm Society member open forum responses
| Resp. | Rec. PPM? | Comments |
|---|---|---|
| 1 | Maybe | Had a similar pt for 10 years without issue. Highlighted need for more data |
| 2 | No | Not without symptoms |
| 3 | Maybe | Highlighted need for topic to be mentioned in guidelines |
| 4 | No | Consider CNA |
| 5 | No | No PPM or CNA without symptoms |
| 6 | No | Had 2 similar pts who developed pauses and symptoms while awake, chose CNA with good results |
| 7 | No | Not without symptoms |
| 8 | No | No PPM regardless of pause length |
| 9 | Maybe | Had a similar pt with 12-second pauses and shaking, would frequently fall out of bed. PPM resolved symptoms. Highlighted need for more data/sleep EEGs. |
| 10 | No | Consider CNA if daytime symptoms |
| 11 | No | CNA if severe daytime bradycardia, or PPM if severe nocturnal pauses with pause-dependent wide QRS ventricular escape beats or NSVT |
| 12 | No | Had 3 similar pts (2 complete HB, 1 sinus pauses) whose arrhythmia burden improved with SSRI (chosen for pro-adrenergic and pro-serotoninergic actions) |
| 13 | Maybe | Had a similar pt in whom PPM resolved diurnal “brain fog.” Recommended broad definition of “symptomatic.” Wondered about thrombotic risk with long pauses |
| 14 | No | Commented that vagotonia from running is not responsible since REM vagal tone is less predominant. Suggested removing culprit medications |
| 15 | Maybe | Had 2 similar pts without issue. Highlighted need for more guidance in literature |
| 16 | No | Recommended de-training in athletic pts but recognized difficulty of adherence |
| 17 | No | Not without daytime symptoms, recommended extended monitoring to detect association with daytime symptoms |
| 18 | Yes | Had a similar pt whom he implanted after discussing with Dr Guilleminault (author of 2011 review)13 owing to theoretical risk of sudden cardiac death |
| 19 | No | Had a pt with pause of 13.8 seconds, no issue with 7 years of follow-up |
| 20 | No | Not without symptoms |
| 21 | No | Would not implant without symptoms but wondered about subclinical brain damage during prolonged asystole |
| 22 | No | Not without presyncope or syncope |
| 23 | Maybe | Had 2 similar pts found on cardiac monitor after cryptogenic stroke. Wondered if pauses caused stroke and if related cerebral hypoperfusion is damaging in elderly pts. Highlighted need for outcomes research |
| 24 | Maybe | Had a similar pt in whom an HCM4 mutation was discovered and subsequently underwent PPM implantation. Recommended genetic testing. |
| 25 | Yes | Had a similar pt who received PPM, AAI mode. Later developed more exertional fatigue on runs; AAIR mode resolved symptoms |
| 26 | Maybe | Highlighted difficulties with lack of prognostic data. Mentioned that a colleague implants PPM for pauses >8 seconds |
| 27 | No | Not without daytime symptoms |
CNA = cardioneural ablation; EEG = electroencephalogram; HB = heart block; NSVT = nonsustained ventricular tachycardia; PPM = permanent pacemaker; Pt(s) – patient(s); Rec. = recommended; REM = rapid eye movement sleep; Resp = respondent; SSRI = selective serotonin release inhibitor.