Sinus node dysfunction (bradycardia and pauses)
Sinus node dysfunction (bradycardia and pauses) Sinus Arrhythmia Sinus Arrhythmia
«Flowchart»

Sinus node dysfunction (bradycardia and pauses)

Sinus node dysfunction (bradycardia and pauses)

Sinus node dysfunction (bradycardia and pauses)

Sinus node dysfunction (bradycardia and pauses)

<Node Text>

<Node Text>

<Node Text>

<Node Text>

<Go to node 3>

<Go to node 3>

<Go to node 3> Node 3

<Go to node 4>

<Go to node 4>

<Go to node 4> Node 4

<End Node 3>

<End Node 3>

<End Node 3>

<End Node 3>

<End Node 4>

<End Node 4>

<End Node 4>

<End Node 4>

Evaluate and treat reversible causes

Evaluate and treat reversible causes

Evaluate and treat reversible causes

Evaluate and treat reversible causes

Pauses <3 sec (or <5 sec in atrial fibrillation)

Pauses <3 sec (or <5 sec in atrial fibrillation)

Pauses <3 sec (or <5 sec in atrial fibrillation) Pauses <3 sec

Pauses >3 sec (or >5 sec in atrial fibrillation)

Pauses >3 sec (or >5 sec in atrial fibrillation)

Pauses >3 sec (or >5 sec in atrial fibrillation) Pauses >3 sec

Consider treadmill testing
to evaluate for chronotropic
incompetence and exertional
symptoms

Consider treadmill testing
to evaluate for chronotropic
incompetence and exertional
symptoms

Consider treadmill testing
to evaluate for chronotropic
incompetence and exertional
symptoms




Asymptomatic

Asymptomatic

Asymptomatic

Symptomatic

Symptomatic

Symptomatic

No treatment
careful F/U

No treatment
careful F/U

No treatment
careful F/U


Permanent PM

Permanent PM

Permanent PM

No correlation
with symptoms

No correlation
with symptoms


No correlation

Pauses associated
with symptoms

Pauses associated
with symptoms


Pauses associated


No treatment if pauses are nocturnal during sleep (vagotonic)
Evaluate for sleep apnea
Test for chronotropic incompetence and exertional symptoms
Consider permanent PM if persistent HR <40 bpm, prolonged pauses


No treatment if pauses are nocturnal during sleep (vagotonic)
Evaluate for sleep apnea
Test for chronotropic incompetence and exertional symptoms
Consider permanent PM if persistent HR <40 bpm, prolonged pauses


No treatment if pauses are nocturnal during sleep (vagotonic)
Evaluate for sleep apnea
Test for chronotropic incompetence and exertional symptoms
Consider permanent PM if persistent HR <40 bpm, prolonged pauses


No treatment if pauses are nocturnal during sleep (vagotonic)
Evaluate for sleep apnea
Test for chronotropic incompetence and exertional symptoms
Consider permanent PM if persistent HR <40 bpm, prolonged pauses

Symptomatic

Symptomatic

Symptomatic

Asymptomatic

Asymptomatic

Asymptomatic