What has NICE recommended on dual‑chamber pacemakers for symptomatic bradycardia?
During the appraisal, NICE's Appraisal Committee read and heard evidence from:
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high‑quality studies of dual‑chamber pacemakers
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doctors with specialist knowledge of symptomatic bradycardia and its treatment
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individuals with specialist knowledge of the issues affecting people with symptomatic bradycardia
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organisations representing the views of people who will be affected by the guidance (because they have, or care for someone with, the condition or because they work in the NHS and are involved in providing care for people with the condition).
The evidence is summarised in the full guidance (see page 10 for details). More information about the studies is provided in the Assessment Report for this appraisal (see page 10 for details).
NICE has made the following recommendations about the use of dual‑chamber pacemakers to treat symptomatic bradycardia within the NHS in England and Wales.
Dual‑chamber pacemakers are recommended to treat symptomatic bradycardia in people with sick sinus syndrome, atrioventricular block, or both. But there are special circumstances where dual‑chamber pacemakers should not be used for symptomatic bradycardia.
When the symptomatic bradycardia is caused by atrioventricular block and the patient has continuous atrial fibrillation (this is a rapid and irregular beating of the upper chamber of the heart),a single‑chamber pacemaker should be used, and it should be attached to the lower chamber of the heart.
Doctors should consider the risks and benefits of using a dual‑chamber pacemaker for individual patients. Patients may be frail or have other medical conditions that may make a dual‑chamber pacemaker unsuitable for them. For these patients, a single‑chamber pacemaker should be used, and should be attached to the lower chamber of the heart.