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Management of bradyarrhythmias 

Management of bradyarrhythmias
Management of bradyarrhythmias

James L. Harrison

and Mark D. O’Neill

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date: 27 January 2022

The process of ageing is associated with an increased incidence of cardiac bradyarrhythmias, which are responsible for significant morbidity and mortality. Structural and functional changes, both mechanical and electrical, occur in the ageing heart, together with alterations in cardiac energetics and metabolism. By the age of 75, the number of functioning pacemaker cells is less than 10%, compared with a young adult. A reduction in automaticity and a slowing of conduction are both common, exacerbated by comorbidities and polypharmacy. Over 80% of pacemakers are implanted in those over 65 years of age. The main indication in these patients is symptomatic bradycardia, due to degenerative sinus node dysfunction or disease of the atrioventricular (AV) node and His-Purkinje system. With careful consideration of risks and benefits, age should not be seen as a contraindication to pacemaker therapy for cardiac bradyarrhythmias.

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