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== | == 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society<ref name="pmid30586772">{{cite journal|author=Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR|display-authors=etal|title=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.|journal=Circulation|year=2019|volume=140|issue=8|pages=e382-e482|pmid=30586772|doi=10.1161/CIR.0000000000000628|pmc=|url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30586772}}</ref> == | ||
== | === Recommendations for Genetic Testing in Documented or Suspected Bradycardia or Conduction Disorders === | ||
{| class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen" |'''1.'''In patients in whom a conduction disorder-causative mutation has been identified, genetic counseling and mutation-specific genetic testing of first-degree relatives is recommended to identify similarly affected individuals. ''(Level of Evidence: C-EO)'' | |||
|} | |||
{| class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | |||
|- | |||
| bgcolor="LemonChiffon" |'''1.'''In patients with inherited conduction disease, genetic counseling and targeted testing may be considered to facilitate cascade screening of relatives as part of the diagnostic evaluation.''(Level of Evidence: C-EO)'' | |||
|} | |||
Genetic mutations may potentially play a role in adult sinus node abnormalities and conduction difficulties, however most are caused by increasing vagal tone or inherited diseases. Despite the rarity of familial disorders of sinus node function and conduction abnormalities, a growing number of genetic mutations have been connected to a variety of abnormalities that may manifest as isolated conduction disease or SND or in conjunction with cardiomyopathy, congenital cardiac anomalies, noncardiac developmental disorders, skeletal muscular disorders, or tachyarrhythmias. | |||
Ion channel regulatory proteins, nuclear envelope proteins, membrane adaptor proteins, transcription factors, sarcoplasmic reticulum calcium handling proteins, gap junctions, cardiac hormones, and sarcomeric proteins are all encoded by the involved genes. | |||
=== Recommendations for Sleep Apnea Evaluation and Treatment in Patients With Documented or Suspected Bradycardia or Conduction Disorders === | |||
{| class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen" |'''1.'''In patients with documented or suspected bradycardia or conduction disorder during sleep, screening for symptoms of sleep apnea syndrome is recommended with subsequent confirmatory testing directed by clinical suspicion. ''(Level of Evidence: B-NR)'' | |||
|- | |||
| bgcolor="LightGreen" |'''2.'''In patients with sleep-related bradycardia or conduction disorder and documented obstructive sleep apnea, treatment directed specifically at the sleep apnea (e.g., continuous positive airway pressure and weight loss) is recommended. ''(Level of Evidence: B-NR)'' | |||
|} | |||
{| class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | |||
|- | |||
| bgcolor="LemonChiffon" |'''1.''' In patients who have previously received or are being considered for a PPM for bradycardia or conduction disorder, screening for sleep apnea syndrome is reasonable. ''(Level of Evidence: B-NR)'' | |||
|} | |||
Nighttime bradyarrhythmias can occur in both healthy and and bradycardia diagnosed people. During sleep, sinus bradycardia is the most typical bradyarrhythmia to occur. However, there are also sporadic instances of sinus arrest, sinus exit block, all types of atrioventricular block, junctional rhythm, and asystole. | |||
==References== | ==References== | ||
Latest revision as of 01:41, 28 December 2022
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2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society[1]
Recommendations for Genetic Testing in Documented or Suspected Bradycardia or Conduction Disorders
| Class I |
| 1.In patients in whom a conduction disorder-causative mutation has been identified, genetic counseling and mutation-specific genetic testing of first-degree relatives is recommended to identify similarly affected individuals. (Level of Evidence: C-EO) |
| Class IIb |
| 1.In patients with inherited conduction disease, genetic counseling and targeted testing may be considered to facilitate cascade screening of relatives as part of the diagnostic evaluation.(Level of Evidence: C-EO) |
Genetic mutations may potentially play a role in adult sinus node abnormalities and conduction difficulties, however most are caused by increasing vagal tone or inherited diseases. Despite the rarity of familial disorders of sinus node function and conduction abnormalities, a growing number of genetic mutations have been connected to a variety of abnormalities that may manifest as isolated conduction disease or SND or in conjunction with cardiomyopathy, congenital cardiac anomalies, noncardiac developmental disorders, skeletal muscular disorders, or tachyarrhythmias.
Ion channel regulatory proteins, nuclear envelope proteins, membrane adaptor proteins, transcription factors, sarcoplasmic reticulum calcium handling proteins, gap junctions, cardiac hormones, and sarcomeric proteins are all encoded by the involved genes.
Recommendations for Sleep Apnea Evaluation and Treatment in Patients With Documented or Suspected Bradycardia or Conduction Disorders
| Class I |
| 1.In patients with documented or suspected bradycardia or conduction disorder during sleep, screening for symptoms of sleep apnea syndrome is recommended with subsequent confirmatory testing directed by clinical suspicion. (Level of Evidence: B-NR) |
| 2.In patients with sleep-related bradycardia or conduction disorder and documented obstructive sleep apnea, treatment directed specifically at the sleep apnea (e.g., continuous positive airway pressure and weight loss) is recommended. (Level of Evidence: B-NR) |
| Class IIa |
| 1. In patients who have previously received or are being considered for a PPM for bradycardia or conduction disorder, screening for sleep apnea syndrome is reasonable. (Level of Evidence: B-NR) |
Nighttime bradyarrhythmias can occur in both healthy and and bradycardia diagnosed people. During sleep, sinus bradycardia is the most typical bradyarrhythmia to occur. However, there are also sporadic instances of sinus arrest, sinus exit block, all types of atrioventricular block, junctional rhythm, and asystole.
References
- ↑ Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR; et al. (2019). "2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society". Circulation. 140 (8): e382–e482. doi:10.1161/CIR.0000000000000628. PMID 30586772.