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What is What are the TOP 10 TAKE-HOME MESSAGES FOR THEMANAGEMENT OF BRADYCARDIA ANDCARDIAC CONDUCTION DELAY? and explain in detail?
1. Sinus node dysfunction is most often related to agedependent progressive fibrosis of the sinus nodal tissue and surrounding atrial myocardium leading toabnormalities of sinus node and atrial impulse formation and propagation and will therefore result invarious bradycardic or pause-related syndromes.JACC VOL. 74, NO. 7, 2019 Kusumoto et al.AUGUST 20, 2019:e51 - 156 2018 Bradycardia Guidelinee532. Both sleep disorders of breathing and nocturnal bradycardias are relatively common, and treatment ofsleep apnea not only reduces the frequency of thesearrhythmias but also may offer cardiovascular benefits. The presence of nocturnal bradycardias shouldprompt consideration for screening for sleep apnea,beginning with solicitation of suspicious symptoms.However, nocturnal bradycardia is not in itself anindication for permanent pacing.3. The presence of left bundle branch block on electrocardiogram markedly increases the likelihood of underlying structural heart disease and of diagnosingleft ventricular systolic dysfunction. Echocardiography is usually the most appropriate initial screeningtest for structural heart disease, including left ventricular systolic dysfunction.4. In sinus node dysfunction, there is no establishedminimum heart rate or pause duration where permanent pacing is recommended. Establishing temporalcorrelation between symptoms and bradycardia isimportant when determining whether permanentpacing is needed.5. In patients with acquired second-degree Mobitz typeII atrioventricular block, high-grade atrioventricularblock, or third-degree atrioventricular block notcaused by reversible or physiologic causes, permanentpacing is recommended regardless of symptoms. Forall other types of atrioventricular block, in theabsence of conditions associated with progressiveatrioventricular conduction abnormalities, permanentpacing should generally be considered only in thepresence of symptoms that correlate with atrioventricular block.6. In patients with a left ventricular ejection fractionbetween 36% to 50% and atrioventricular block, whohave an indication for permanent pacing and are expected to require ventricular pacing >40% of the time,techniques that provide more physiologic ventricularactivation (e.g., cardiac resynchronization therapy,His bundle pacing) are preferred to right ventricularpacing to prevent heart failure.7. Because conduction system abnormalities are common after transcatheter aortic valve replacement,recommendations on postprocedure surveillance andpacemaker implantation are made in this guideline.8. In patients with bradycardia who have indications forpacemaker implantation, shared decision-making andpatient-centered care are endorsed and emphasized inthis guideline. Treatment decisions are based on thebest available evidence and on the patients goals ofcare and preferences.9. Using the principles of shared decision-making andinformed consent/refusal, patients with decisionmaking capacity or his/her legally defined surrogatehas the right to refuse or request withdrawal ofpacemaker therapy, even if the patient is pacemakerdependent, which should be considered palliative,end-of-life care, and not physician-assisted suicide.However, any decision is complex, should involve allstakeholders, and will always be patient specific.10. Identifying patient populations that will benefit themost from emerging pacing technologies (e.g., Hisbundle pacing, transcatheter leadless pacing systems)will require further investigation as these modalitiesare incorporated into clinical practice.