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August 20, 2019 Circulation. 2019;140:e382–e482. DOI: 10.1161/CIR.0000000000000628 e390

CLINICAL STATEMENTS AND GUIDELINES Kusumoto et al 2018 Bradycardia Clinical Practice Guidelines

Table 3.  Table of Definitions

Term Definition or Description Sinus node dysfunction (with accompanying symptoms) Sinus bradycardia: Sinus rate <50 bpm

Ectopic atrial bradycardia: Atrial depolarization attributable to an atrial pacemaker other than the sinus node with a rate <50 bpm Sinoatrial exit block: Evidence that blocked conduction between the sinus node and adjacent atrial tissue is present. Multiple electrocardiographic manifestations including “group beating” of atrial depolarization and sinus pauses. Sinus pause: Sinus node depolarizes >3 s after the last atrial depolarization Sinus node arrest: No evidence of sinus node depolarization Tachycardia-bradycardia (“tachy-brady”) syndrome: Sinus bradycardia, ectopic atrial bradycardia, or sinus pause alternating with periods of abnormal atrial tachycardia, atrial flutter, or AF.S2.1-1 The tachycardia may be associated with suppression of sinus node automaticity and a sinus pause of variable duration when the tachycardia terminates. Chronotropic incompetence: Broadly defined as the inability of the heart to increase its rate commensurate with increased activity or demand, in many studies translates to failure to attain 80% of expected heart rate reserve during exercise. Isorhythmic dissociation: Atrial depolarization (from either the sinus node or ectopic atrial site) is slower than ventricular depolarization (from an atrioventricular nodal, His bundle, or ventricular site).

Atrioventricular blockS2.1-2 First-degree atrioventricular block: P waves associated with 1:1 atrioventricular conduction and a PR interval >200 ms (this is more accurately defined as atrioventricular delay because no P waves are blocked)

Second-degree atrioventricular block: P waves with a constant rate (<100 bpm) where atrioventricular conduction is present but not 1:1 Mobitz type I: P waves with a constant rate (<100 bpm) with a periodic single nonconducted P wave associated with P

waves before and after the nonconducted P wave with inconstant PR intervals Mobitz type II: P waves with a constant rate (< 100 bpm) with a periodic single nonconducted P wave associated with

other P waves before and after the nonconducted P wave with constant PR intervals (excluding 2:1 atrioventricular block) 2:1 atrioventricular block: P waves with a constant rate (or near constant rate because of ventriculophasic sinus arrhythmia)

rate (<100 bpm) where every other P wave conducts to the ventricles Advanced, high-grade or high-degree atrioventricular block: ≥2 consecutive P waves at a constant physiologic rate that do

not conduct to the ventricles with evidence for some atrioventricular conduction Third-degree atrioventricular block (complete heart block): No evidence of atrioventricular conduction Vagally mediated atrioventricular block: Any type of atrioventricular block mediated by heightened parasympathetic tone

Infranodal block: atrioventricular conduction block where clinical evidence or electrophysiologic evidence suggests that the conduction block occurs distal to the atrioventricular node

Conduction tissue diseaseS2.1-2 RBBB (as defined in adults):

Complete RBBB 1.  QRS duration ≥120 ms 2.  rsr′, rsR′, rSR′, or rarely a qR in leads V1 or V2. The R′ or r′ deflection is usually wider than the initial R wave. In a

minority of patients, a wide and often notched R wave pattern may be seen in lead V1 and/or V2. 3.  S wave of greater duration than R wave or >40 ms in leads I and V6 in adults 4.  Normal R peak time in leads V5 and V6 but >50 ms in lead V1 Incomplete RBBB: Same QRS morphology criteria as complete RBBB but with a QRS duration between 110 and 119 ms LBBB (as defined in adults): Complete LBBB: 1.  QRS duration ≥120 ms in adults 2.  Broad notched or slurred R wave in leads I, aVL, V5, and V6 and an occasional RS pattern in V5 and V6 attributed to

displaced transition of QRS complex 3.  Absent Q waves in leads I, V5, and V6, but in the lead aVL, a narrow Q wave may be present in the absence of

myocardial pathology 4.  R peak time >60 ms in leads V5 and V6 but normal in leads V1, V2, and V3, when small initial R waves can be discerned

in the precordial leads 5.  ST and T waves usually opposite in direction to QRS Incomplete LBBB: 1.  QRS duration between 110 and 119 ms in adults 2.  Presence of left ventricular hypertrophy pattern 3.  R peak time >60 ms in leads V4, V5, and V6 4.  Absence of Q wave in leads I, V5, and V6

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