The cardiac implantable electronic device (CIED) is the therapy of choice for management of symptomatic bradyarrhythmias. However, the indication for CIED implantation in the cases of asymptomatic bradycardias should be carefully individualized. Incidental electrocardiographic findings in asymptomatic patients (e.g., low baseline heart rates, higher than first-degree atrioventricular block or longer pauses) may complicate the physician's decision regarding the necessity of CIED implantation. The main reason is the inherit risk of short- and long-term complications with every CIED implantation, i.e., peri-operative complications, risk of CIED infection, lead fractures, and the necessity for lead extraction. Therefore, before opting for, or against, CIED implantation, several factors should be considered in the subset of asymptomatic patients.
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Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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Department of Medicine, Division of Cardiology, Weill Cornell Medicine-New York Presbyterian Hospital and Weill Cornell Cardiovascular Outcomes Research Group (CORG), 520 East 70th Street 4th Floor, New York, NY 10021, USA.
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