Heart Rhythm Society

View all recommendations from this society

Released February 10, 2014

Don’t implant pacemakers for asymptomatic sinus bradycardia in the absence of other indications for pacing.

While pacemaker implantation is clearly indicated in patients with symptomatic sinus node dysfunction, there is no clear evidence that pacemaker implantation benefits asymptomatic patients with sinus bradycardia who have no other reasons for pacing nor need for cardiac resynchronization. Although pacemaker implantation is a relatively low-risk surgical procedure, like any operation, there is both risk and cost. Furthermore, persistent inappropriate right ventricular pacing may have harmful effects on heart function. Current professional society clinical guidelines recommend against (Class III, contraindicated) pacemaker implantation in these patients where the risks outweigh the benefits.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Heart Rhythm Society (HRS) asked its standing Quality Improvement Subcommittee, comprised of twelve experienced physicians and allied professionals, to recommend five procedures that should not be performed or should be performed more rarely and only in specific circumstances. The recommendations were identified based on existing appropriate use criteria and guidelines. The HRS Health Policy Committee then reviewed the five recommendations before sending the list to the HRS Board of Trustees for final review and approval.

HRS’s disclosure and conflict of interest policy can be found at http://www.hrsonline.org/About-HRS/Heart-Rhythm-Society-Governance/Disclosure-Policy#axzz2ILTZwIkZ.


Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW; American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices); American Association for Thoracic Surgery; Society of Thoracic Surgeons. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to revise the ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008 May 27;51(21):e1–62.