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Bradycardia is a medical condition in which the heart rate is slower than normal. It occurs when the heart's natural pacemaker, the sinus node, generates slower electrical impulses than the standard rhythm. In adults, bradycardia is diagnosed when the pulse rate falls below 60 beats per minute, indicating a deviation from the normal heart rate range.
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Under-utilization of pacemaker therapy for sinus node dysfunction - Real world data from South Asia.

C Narasimhan1, J Sanyal2, R Sethi3

  • 1Division of Electrophysiology, Department of Cardiology, CARE Hospitals and CARE Foundation, Hyderabad, India.

Indian Heart Journal
|October 22, 2017
PubMed
Summary

In South Asia, only 17% of patients with symptomatic sinus node dysfunction (SND) received pacemaker therapy, primarily due to patient refusal and physician decisions. Further quality improvement initiatives are planned to increase treatment rates for this common bradyarrhythmia.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Public Health

Background:

  • Sinus node dysfunction (SND) is the most common cause of bradyarrhythmia, often managed with permanent cardiac pacing.
  • Understanding the care pathway and barriers to pacemaker adoption is crucial, especially in low-volume implanting regions.
  • The IMPROVE Brady study is a quality improvement initiative assessing SND diagnosis and treatment in South Asia.

Purpose of the Study:

  • To assess the rates of SND diagnosis and pacemaker treatment in the South Asian cohort of the IMPROVE Brady study.
  • To identify barriers to pacemaker therapy adoption for symptomatic SND in this region.

Main Methods:

  • Prospective enrollment of 508 patients with heart rate ≤50 bpm and symptoms like syncope, dizziness, or dyspnea from ten centers in India and Bangladesh.
  • Follow-up to determine the proportion diagnosed with SND and subsequently treated with pacemakers.

Main Results:

  • SND was diagnosed in 72% of enrolled patients, with 80% diagnosed within one month.
  • Only 17% (63 out of 368) of diagnosed SND patients received pacemaker therapy.
  • Key reasons for non-treatment included patient refusal (45%), unaffordability (34%), and physician-determined non-indication (20%).

Conclusions:

  • In South Asia, a significant gap exists in pacemaker therapy for symptomatic SND, with only 1 in 6 patients receiving indicated treatment.
  • Patient refusal and physician decisions are major barriers to pacemaker implantation.
  • Phase II of the IMPROVE Brady study aims to improve pacemaker treatment rates for SND.