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NICE TA324 Dual chamber pacemakers for symptomatic bradycardia due to sick sinus syndrome without atrioventricular block (November 2014)
These are invariably benign and rarely need treatment (apart from reassurance). Beta-blockers can provide symptomatic relief in some patients but often the side effects of treatment are worse than the symptoms of the problem. More potent antiarrhythmic agents such as flecainide and amiodarone should not be initiated in primary care. Refer patients with structural heart disease, syncope or effort related arrhythmia to cardiology.
This is a difficult arrhythmia to treat medically. Sotalol or amiodarone may help, flecainide should be avoided. The rules for anticoagulation are the same as for atrial fibrillation. Rate control is with digoxin, beta-blockers or verapamil. The optimal treatment is radiofrequency ablation so refer to cardiology.
Supraventricular tachycardia or ventricular tachycardia should be referred to cardiology