Is a heart pause, also known as (cardiac) sinus pause, okay?

From the Guidelines

A heart pause, in the context of a sinus pause, is generally okay and does not require treatment in asymptomatic individuals, especially in young individuals or well-conditioned athletes with dominant parasympathetic tone at rest. This is supported by the 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay, which states that sinus bradycardia or pauses are common during rest and sleep, and are often asymptomatic 1.

Key Points to Consider

• Sinus bradycardia or pauses are common in individuals with high vagal tone, and are often observed during rest or sleep 1.
• Asymptomatic or minimally symptomatic patients with sinus node dysfunction (SND) have no indication for permanent pacing, as the benefit of permanent cardiac pacing is essentially symptom relief and quality of life (QOL) improvement 1.
• Anti-bradycardia therapy is not indicated in almost all cases of sinus bradycardia or pauses, and patients should be reassured 1.

Clinical Implications

• Clinicians should avoid anti-bradycardia therapy in asymptomatic patients with sinus bradycardia or pauses, and instead focus on reassurance and monitoring 1.
• Permanent pacing is associated with surgical risk and long-term consequences, and should only be considered in symptomatic patients with SND 1.
• The use of wearable home monitoring systems and continuous telemetry monitoring in hospital settings may lead to the detection of sinus bradycardia or pauses, but these findings should be interpreted in the context of the patient's symptoms and clinical presentation 1.

From the Research

Heart Pause Overview

• A heart pause, also known as an electrocardiographic pause, refers to a prolonged R-R interval that represents an interruption in ventricular depolarization 2.
• The occurrence of pauses can be related to various factors, including low heart rate, physical activity level, and smoking habits 3.

Clinical Significance of Heart Pauses

• In patients with atrial fibrillation, prolonged electrocardiographic pauses of ≥2.5 s or ≥3.0 s are not a marker for increased mortality 4.
• However, pauses in patients referred to Holter due to syncope and/or dizzy spells were associated with an increased risk of pacemaker treatment 4.
• The optimal interval at which to pause chest compressions for cardiac rhythm analysis in adults is not well established, with very low-quality evidence suggesting improved clinical outcomes with 200-compression intervals compared to 1- or 3-min intervals 5.

Diagnostic Approach to Heart Pauses

• A diagnostic approach to pauses on the ECG should consider various causes, including sinus node dysfunction 2.
• Holter monitoring can be used to detect and analyze heart pauses, providing valuable information on minimal heart rates and longest pauses in healthy adult subjects 3.

Treatment and Management

• Beta blockers are often used as a first-line treatment for arrhythmias, including supraventricular tachycardia and ventricular tachyarrhythmias 6.
• The choice of drug, dose, and route of administration depends on the type of arrhythmia and clinical presentation, as well as patient demographics 6.