This guidance has been partially updated by NICE technology appraisal 324..

Dual-chamber pacemakers are recommended to treat symptomatic bradycardia in people with sick sinus syndrome, atrioventricular block, or both. But there are a number of special circumstances where dual-chamber pacemakers should not be used for symptomatic bradycardia.

The first of these circumstances is when the symptomatic bradycardia is caused by sick sinus syndrome, but the flow of electrical impulses between the upper and lower chambers of the patient's heart is normal. When this happens, a single-chamber pacemaker should be used. When the pacemaker is fitted to these patients, it should be attached to the upper chamber of the heart.

The second is 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). When this happens 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.

Your responsibility

The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.