In patients with infrequent unexplained syncope, in whom a comprehensive evaluation did not demonstrate a cause, long-term ambulatory monitoring with an implantable loop recorder is recommended. Screening for sleep apnea syndrome is recommended in patients with symptoms of sleep apnea syndrome and in the presence of severe bradycardia or advanced atrioventricular (AV) block during sleep. Exercise testing is recommended in patients who experience symptoms suspicious of bradycardia during or immediately after exertion.
In patients with suspected or documented symptomatic bradycardia, the use of cardiac imaging is recommended to evaluate the presence of structural heart disease, to determine left ventricular (LV) systolic function, and to diagnose potential reversible causes of conduction disturbances. The following are key points to remember from the European Society of Cardiology (ESC) and the European Heart Rhythm Association (EHRA) about the 2021 Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy (CRT):Ī careful history and physical examination are essential for the evaluation of patients with suspected or documented bradycardia.
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