7 Implementation and audit

7 Implementation and audit

7.1 Clinicians who care for people who have symptomatic bradycardia associated with sick sinus syndrome and/or atrioventricular block should review their current practice and policies to take account of the guidance set out in Section 1.

7.2 Local guidelines, protocols or care pathways that refer to the care of people with symptomatic bradycardia associated with sick sinus syndrome and/or atrioventricular block should incorporate the guidance.

7.3 To measure compliance locally with the guidance, the following criteria could be used. Further details on suggestions for audit are presented in Appendix C.

7.3.1 Dual‑chamber pacing is used for the management of symptomatic bradycardia due to sick sinus syndrome, atrioventricular block, or a combination of sick sinus syndrome and atrioventricular block, except in the following circumstances:

  • in the management of sick sinus syndrome in a patient for whom, after full evaluation, there is no evidence of impaired atrioventricular conduction; in this situation, single‑chamber atrial pacing is used

  • in the management of atrioventricular block in a patient with continuous atrial fibrillation; in this situation, single‑chamber ventricular pacing is used

  • in the management of atrioventricular block (atrioventricular block alone or in combination with sick sinus syndrome), when patient‑specific factors influence the balance of risks and benefits in favour of single‑chamber ventricular pacing.

7.4 The Central Cardiac Audit Database, which is part of the National Clinical Audit Support Programme, includes the collection of data on the use of cardiac pacemakers.