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Bradycardia Guideline 2018

CardioSmart News
Bradycardia is a condition that occurs when your heart rate is too slow. In light of research over the past decade, experts have released new guidelines about managing bradycardia. The American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society recently published the update in the Journal of the American College of Cardiology. 

Here’s what every patient should know about this condition and the new guidelines.

About Bradycardia

Bradycardia is a medical term for a slow heart rate. In the past, it has been defined as a heart rate less than 60 beats per minute.

For some patients, bradycardia may cause no symptoms or problems. However, a slow heart rate can cause dizziness, fatigue and shortness of breath. It can also lead to heart failure or sudden cardiac arrest if the heart is unable to pump enough blood to the rest of the body.


For some people — such as younger people and athletes — a slower heart rate is normal, and they don’t need to do anything. For those who need treatment, their options will  depend on the type of problem, what’s causing it, and their symptoms.

Underlying disorders can cause or make bradycardia worse, so treating those conditions may correct the heart rate. However, sometimes treatment may include devices placed in the body to monitor and correct a slow heartbeat such as a pacemaker, implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy device (CRT). 

Go to www.CardioSmart.org/Bradycardia to learn more about this condition.

New Guidelines

The 2018 guidelines will help clinicians manage patients with bradycardia or those suspected to have the condition. This document replaces recommendations from 2008 (and updated in 2012) on the use of devices for treating bradycardia. The latest guidelines take a broader approach by focusing on managing the condition overall.

Key Updates for Patients

  • The guidelines update the definition of sinus node dysfunction, which is one of the causes of bradycardia. Sinus node dysfunction means the heart’s natural pacemaker isn’t working the way it should. In the past, anything fewer than 60 beats per minute has been considered slower than normal. The new guidelines say sinus node dysfunction includes a heart rate less than 50 beats per minute, or at least a 3-second pause in between heartbeats — or both.

  • It is important to screen for sleep apnea in patients with suspected bradycardia. The common sleep disorder occurs when a person’s breathing stops or becomes very shallow while he or she sleeps. Sleep apnea can cause  bradycardia, make it worse, or do both. So, screening for it is important when patients are suspected to have a slow heartbeat.

  • Reasons for considering a pacemaker in patients with bradycardia have been updated. In some cases, the threshold has been lowered so that the device may be considered in a broader group of patients.

  • Shared decision-making should be part of the treatment discussions between patients and their health professionals. Those principles are also important when talking about end-of-life care with patients who may want to stop certain treatments as their health declines.

  • Finally, more research is needed on long-term outcomes for bradycardia. It would help identify how well treatments work and for how long. It also would help show which types of patients stand to benefit most from certain treatments.

Read the full text of the guidelines: "2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients with Bradycardia and Cardiac Conduction Delay."

Learn about CardioSmart's editorial process. Information provided for educational purposes only. Please talk to your health care professional about your specific needs.