Recommendations for Permanent Pacing in Sinus Node Dysfunction

Class I
(1) Permanent pacemaker implantation is indicated for sinus node dysfunction with documented symptomatic bradycardia, including frequent sinus pauses that produce symptoms.

(2) Permanent pacemaker implantation is indicated
for symptomatic chronotropic incompetence.

(3) Permanent pacemaker implantation is indicated
for symptomatic sinus bradycardia that results from required drug therapy for medical conditions.


Class IIa
(1) Permanent pacemaker implantation is reasonable for SND with heart rate less than 40 bpm when a clear association between significant symptoms consistent with bradycardia and the actual presence of bradycardia has not been documented.

(2) Permanent pacemaker implantation
is reasonable for syncope of unexplained origin when clinically significant abnormalities of sinus node function are discovered or provoked in electrophysiological studies.


Class IIb
(1) Permanent pacemaker implantation may be considered in minimally symptomatic patients with chronic heart rate less than 40 bpm while awake.

Class III
(1) Permanent pacemaker implantation is not indicated for SND in asymptomatic patients.

(2) Permanent pacemaker implantation is not indicated for SND in patients for whom the symptoms suggestive of bradycardia have been clearly documented to occur in the absence of bradycardia

(3) Permanent pacemaker implantation is not indicated
for SND with  symptomatic bradycardia due to nonessential drug therapy.



JACC. 2008; 51; 2085-2105.