When is a permanent pacemaker indicated in patients with sick sinus syndrome or complete heart block?

A permanent pacemaker is indicated primarily for symptomatic patients with sick sinus syndrome or complete heart block. Symptoms may include syncope, dizziness, fatigue, or heart failure, which can significantly impair a patient's quality of life. In symptomatic cases, the risk of serious complications increases, and a pacemaker can effectively restore normal heart rhythm and improve symptoms.

Asymptomatic patients typically do not require a permanent pacemaker, as the risks of the procedure may outweigh the benefits without the presence of symptoms. While age can be a factor in treatment decisions, it is not a standalone indication for pacing; the presence of symptoms is key in guiding the decision. Additionally, the placement of a pacemaker is not confined to the context of invasive procedures, as the indication for a pacemaker arises from the patient's clinical status rather than the procedural setting. Thus, the primary reason for pacing is to alleviate symptoms in patients who are symptomatic from their cardiac conduction abnormalities.