This activity was planned with a goal to improve your competence in evaluating and managing patients with bradycardia. This case was created in response to the 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay.

Accreditation Statement

Physicians
The American College of Cardiology Foundation (ACCF) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The ACCF designates this enduring material for a maximum of up to .25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

While offering CME credits noted above, this program is not intended to provide extensive training or certification in the field.

Nurses
The American College of Cardiology Foundation (ACCF) is accredited as a provider of continuing nursing education by The American Nurses Credentialing Center's Commission on Accreditation.

The ACCF designates this educational activity for a maximum of .25 continuing education hours.

While offering the CNE credits noted above, the course is not intended to provide extensive training or certification in the field.

MOC
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to .25 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Target Audience

This activity is intended for adult cardiovascular physicians, family physicians, internists, nurse practitioners, and physician assistants.

Important Dates:

Date of Release: February 20, 2019
Term of Approval/Date of CME/CE Expiration: February 20, 2022

Learner Objectives
Upon completion of this program, you should be able to:

• Describe the differential diagnosis of nocturnal sinus bradycardia.
• Discuss the role of autonomic function in establishing sinus rate.
• Explain the importance of recognizing and treating obstructive sleep apnea.
• Explain the role of permanent pacing for symptomatic sinus bradycardia.

Method of Participation and CME/CNE Certificate
Requesting AMA PRA Category 1 CME Credit™ and continuing education credit for this activity

To request credit, you must:

• Read all text and view all tables and/or figures in the case for which you wish to receive credit.
• Answer the questions in each case for which you wish to claim credit. After you have answered all the questions, click on the Exam Summary button. A Claim Credit button will appear on this page if you have achieved a passing score of 70% or better. If you did not achieve a passing score, please click the Reset Scores link and retake the exam.
• Click the Claim Credit button and answer the evaluation questions in the pop-up window.
• Enter the total amount of time you actually spent in the activity in the box provided. Please note that you may only claim once for each module in this activity. Click Submit.
• You will receive a message that your request has been submitted and a link to view your certificate. You may view and download the certificate when you receive the message, you may also view it at any time in the My Transcript section of My ACC.

This CME/CNE-certified activity may contain links to other educational resources such as clinical trial summaries, journal articles, guidelines, etc., that may not be CME/CNE-certified. Please note that clicking on the links provided to view these resources will open new windows, which are outside of this CME/CNE-certified activity.

Authors:
Joseph E. Marine, MD, FACC

Peer Reviewers:
Zachary D. Goldberger, MD, FACC
Mahmoud Houmsse, MD, FACC
M. Dominique Ashen, PhD, CRNP
Jennifer Host, CNP

Nurse Planner:
Kimberly V. Cheramie, MSN