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Kusumoto et al 2018 Bradycardia Clinical Practice Guidelines

Circulation. 2019;140:e382–e482. DOI: 10.1161/CIR.0000000000000628 August 20, 2019 e389 CLINICAL STATEMENTS AND GUIDELINES

the most commonly used definition in the literature has been failure to reach 80% of the expected heart rate reserve. Expected heart rate reserve is defined as the difference between the age-predicted maximal heart rate (220–age) and the resting heart rate. Percentage of expected heart rate reserve is the ratio of demonstrated and predicted heart rate reserve. Although this definition has been used in literature, in practice, specifically defining chronotropic incompetence is difficult.S2.2-8–S2.2- 11 Other investigators suggest that another age-related equation (220 − 0.7 × age) is a better predictor for heart rate, while others stress the importance of sex and the presence of comorbidities.S2.2-8–S2.2-10 Collectively, the data suggest that the diagnosis of chronotropic incompetence in a patient requires careful individualized clinical assessment and probably cannot be determined by age alone. The definitions for atrioventricular block and conduction tissue disorders have been adopted from the 2009 AHA/ACCF/HRS recommendations for the standardization of electrocardiographic measurements (both intraventricular conduction disorders and chamber hypertrophy),S2.2-7,S2.2-12 although some have argued that stricter criteria are required for left bundle branch block (LBBB).S2.2-13

Table 2.  Applying Class of Recommendation and Level of Evidence to Clinical Strategies, Interventions, Treatments, or Diagnostic Testing in Patient Care* (Updated August 2015)

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