Management of Sinus Bradycardia with Premature Atrial Contractions (PACs)

Initial Evaluation and Management

• The American College of Cardiology recommends evaluating for reversible causes of sinus bradycardia, including medications and electrolyte abnormalities, in patients with sinus bradycardia and PACs 1, 2
• Assess for symptoms directly attributable to bradycardia, such as syncope, presyncope, and dizziness, in patients with sinus bradycardia and PACs 4, 3

Management Algorithm Based on Symptom Severity

• The American College of Cardiology recommends no treatment for asymptomatic sinus bradycardia, especially in young individuals, athletes, or during sleep, and monitoring for development of symptoms or progression of bradycardia 2, 5, 4
• Avoid unnecessary permanent pacemaker implantation in asymptomatic patients with sinus bradycardia 5, 6

Pacing Recommendations When Indicated

• The American Heart Association recommends atrial-based pacing over single chamber ventricular pacing in symptomatic patients with sinus node dysfunction (SND) 7
• In symptomatic patients with SND and intact AV conduction without evidence of conduction abnormalities, dual chamber or single chamber atrial pacing is recommended 7

Common Pitfalls to Avoid

• Failing to identify reversible causes before proceeding to permanent pacing can lead to unnecessary pacemaker implantation, according to the American College of Cardiology 1, 5