New ACC/AHA/HRS Guideline on Evaluating, Managing Bradycardia

New ACC/AHA/HRS Guideline on Evaluating, Managing Bradycardia

A new guideline released today by the ACC, American Heart Association (AHA) and the Heart Rhythm Society (HRS) outlines the clinical presentation and approach to clinical evaluation of patients who may have bradycardia or conduction diseases.

In developing the 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients with Bradycardia and Cardiac Conduction Delay, the writing committee reviewed study data and developed recommendations addressing the selection and timing of diagnostic testing tools, as well as available treatment options such as lifestyle interventions, pharmacotherapy and external and implanted devices.

Specifically, the guideline describes the clinical significance of bradycardia with respect to mortality, symptoms (i.e., syncope and impaired functional capacity) and exacerbations of related disorders like ischemia, heart failure and provoked tachyarrhythmias. It also aims to delineate the clinical presentation and general approach to clinical evaluation of patients with overt or suspected bradycardias or conduction diseases.

The writing committee also looked at special considerations for different populations based on age, comorbidities or other relevant factors. Key to addressing special considerations well: shared decision-making between the patient and clinicians, as well as patient-centered care. “Treatment decisions are based not only on the best available evidence but also on the patient’s goals of care and preferences,” says Fred M. Kusumoto, MD, FACC, chair of the writing committee. “Patients should be referred to trusted material to aid in their understanding and awareness of the consequences and risks of any proposed action.”

Visit the Bradycardia and Cardiac Conduction Delay Guideline Hub on for resources including a slide set, perspectives, apps and tools, and CardioSmart patient resources. The Bradycardia Guideline Hub on JACC also features tools including the central illustration.