Bradycardia

Asymptomatic patients

• Do not need regular follow-up. May monitor themselves as outpatients and notify their doctors only when they develop cardinal symptoms.

Symptomatic

• Symptomatic patients should be seen by a physician, preferably a cardiologist, as soon as possible, with appropriate testing undertaken to establish the degree and mechanism of bradycardia and whether symptoms are secondary to the rhythm.

• Follow-up at this point depends on the type of diagnostic modality used. For example, if the patient has an event monitor, the follow-up should happen at the end of 30 days or before this if a patient transmission demonstrates a concerning rhythm correlating with symptoms.

• Similarly, if a patient has an implantable-loop recorder, he or she should be followed up if a symptomatic episode occurred that caused the patient to activate the device. Routine follow-up in patients with implantable-loop recorders can be every 3-6 months for the battery life of the device (i.e., usually 18-24 months).

Pacemaker implantation

• A cardiologist, preferably an electrophysiologist, must follow patients after a pacemaker has been implanted.

• The initial follow-up should be 1 week after implant to assess the pocket and incision site for possible infection.

• 2-month follow-up must occur after pacemaker implantation and then yearly thereafter.

• The reason for frequent yearly follow-up is to assess the device for lead function and battery life, and to review any events that were recorded by the device.