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Sleep evaluation Screening for SAS is recommended in patients with symptoms of SAS and in the presence of severe bradycardia or advanced AVB during sleep. I C Recommendation for implantable loop recorder In patients with infrequent (less than once a month) unexplained syncope or other symptoms suspected to be caused by bradycardia in whom a comprehensive evaluation did not demonstrate a cause, long-term ambulatory monitoring with an ILR is recommended. I A Cardiac pacing for bradycardia and conduction system disease In patients with SND and a DDD pacemaker, minimization of unnecessary ventricular pacing through programming is recommended. I A Pacing is indicated in SND when symptoms can clearly be attributed to bradyarrhythmias. I B Pacing is indicated in symptomatic patients with the bradycardiatachycardia form of SND to correct bradyarrhythmias and enable pharmacological treatment, unless ablation of the tachyarrhythmia is preferred. I B Pacing is not recommended in patients with bradyarrhythmias related to SND which are asymptomatic or due to transient causes that can be corrected and prevented. III C Pacing is indicated in patients in SR with permanent or paroxysmal third- or second-degree type 2, infranodal 2:1, or highdegree AVB, irrespective of symptoms.e I C Pacing is indicated in patients with atrial arrhythmia (mainly AF) and permanent or paroxysmal third- or high-degree AVB, irrespective of symptoms. I C In patients with permanent AF in need of a pacemaker, ventricular pacing with rate response function is recommended. I C Pacing is not recommended in patients with AVB due to transient causes that can be corrected and prevented. III C In patients with unexplained syncope and bifascicular block, a pacemaker is indicated in the presence of either a baseline HV interval of >_70 ms, second- or third-degree intra- or infra-Hisian block during incremental atrial pacing, or abnormal response to pharmacological challenge. I B Pacing is indicated in patients with alternating BBB with or without symptoms. I C Pacing is not recommended for asymptomatic BBB or bifascicular block. III B Recommendations for pacing for reflex syncope Dual-chamber cardiac pacing is indicated to reduce recurrent syncope in patients aged >40 years, with severe, unpredictable, recurrent syncope who have: • spontaneous documented symptomatic asystolic pause(s) >3 s or asymptomatic pause(s) >6 s due to sinus arrest or AVB; or • cardioinhibitory carotid sinus syndrome; or • asystolic syncope during tilt testing. I A Cardiac pacing is not indicated in the absence of a documented cardioinhibitory reflex. III B Pacing is not recommended in patients with unexplained falls in the absence of any other documented indication. III B Pacing is not recommended in patients with unexplained syncope without evidence of SND or conduction disturbance. III C CRT CRT is recommended for symptomatic patients with HF in SR with LVEF <_35%, QRS duration >_150 ms, and LBBB QRS morphology despite OMT, to improve symptoms and reduce morbidity and mortality. I A CRT is not indicated in patients with HF and a QRS duration <130 ms without indication for RV pacing. III A In patients with symptomatic AF and an uncontrolled heart rate who are candidates for AVJ ablation (irrespective of QRS duration), CRT is recommended in patients with HFrEF. I B CRT rather than RV pacing is recommended for patients with HFrEF (<40%) regardless of NYHA class who have an indication for ventricular pacing and high-degree AVB in order to reduce morbidity. This includes patients with AF. I A In patients who are candidates for an ICD, and who have CRT indication, implantation of a CRT-D is recommended. I A Recommendations for using His bundle pacing In patients treated with His bundle pacing, device programming tailored to specific requirements of His bundle pacing is recommended. I C Pacing in acute myocardial infarction Implantation of a permanent pacemaker is indicated with the same recommendations as in a general population (section 5.2) when AVB does not resolve within a waiting period of at least 5 days after MI. I C Pacing is not recommended if AVB resolves after revascularization or spontaneously. III B

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