Implantation of Cardiac Pacemakers in Patients With Baseline Bradycardia: An Unresolved Issue

Given the strength of evidence supporting beta blocker therapy in patients with symptomatic HF, some physicians would consider pacemaker implantation when symptomatic bradycardia or heart block occurs during the initiation of this therapy. No clinical trial data are available to support this practice. Data from a decision analysis/cost-effectiveness modeling study suggested that prophylactic pacemaker insertion to allow beta blocker treatment in patients with bradycardia may be associated with clinical benefits, and may be cost-effective.14 However, this approach cannot be recommended in the absence of clinical data.6,14 It should be recognized that right ventricular (RV) pacing alone may result in deterioration of ventricular function, negating any potential benefit from beta blockade.61 Consideration should be given to the withdrawal of other drugs that may have bradycardic effects.