Indications For Permanent Cardiac Pacemaker
From Anvita Health Wiki
Introduction
- complete heart block with any complication
- symptomatic bradycardia
- congestive heart failure
- ectopy requiring pharmacologic suppression
- asystole > 3.0 seconds
- bradycardia < 40 beats/min
- post AV junction ablation
- myotonic dystrophy
- confusional states that clear with temporary pacing
- 2nd degree AV block (type 1 or 2) with symptomatic bradycardia
- atrial fibrillation or flutter with symptomatic bradycardia related to AV nodal blocking agents necessary to control ventricular response
- pacing controversial
- asymptomatic complete heart block with ventricular rate > 40 beats/min
- asymptomatic 2nd degree heart block type 2
- asymptomatic 2nd degree heart block type 1 at His bundle*
- pacing unnecessary
- 1st degree AV block
- asymptomatic 2nd degree heart block type 1 at supra- His bundle (AV nodal) level
- After myocardial infarction
- pacing indicated
- persistent advance 2nd degree or 3rd degree AV block in the His-Purkinje* system
- transient advanced AV block associated with bundle branch block
- pacing controversial
- persistent advanced AV block
- pacing unnecessary
- transient AV conduction disturbances in the absence of intraventricular conduction defects
- transient AV block with isolated left anterior hemiblock
- acquired left anterior hemiblock without AV block
- persistent 1st degree AV block with new bundle branch block
- Bifascicular & trifascicular block
- pacing indicated
- bifascicular block with intermittent complete heart block associated with symptomatic bradycardia
- bifascicular or trifascicular block with intermittent asymptomatic 2nd degree type 2 AV block
- pacing controversial
- syncope that is not proven related to heart block
- markedly prolonged heart block
- pacing-induced infra-His block
- pacing unnecessary
- fascicular block without AV block or symptoms
- fascicular block with asymptomatic 1st degree AV block
- Sinus node dysfunction
- pacing indicated
- sinus node dysfunction with symptomatic bradycardia (may occur as a result of pharmaceutical therapy for which there are no long-term acceptable alternatives)
- pacing controversial
- sinus node dysfunction occurring spontaneously or as a result of drug therapy, with heart rate < 40/min without clear association of symptoms with bradycardia
- pacing unnecessary
- sinus node dysfunction with asymptomatic bradycardia, including those with heart rate < 40/min resulting from long-term pharmaceutical therapy
- sinus node dysfunction with symptoms found NOT be be associated with bradycardia
- Hypersensitive carotid sinus & neovascular syndromes
- pacing indicated
- recurrent syncope associated with clear, spontaneous events provoked by carotid sinus stimulation (minimal carotid sinus pressure induces asystole > 3.0 seconds in duration in the absence of medication that depresses the sinus node or AV conduction)
- pacing controversial
- recurrent syncope without clear, provocative events & with a hypersensitive cardioinhibitory response
- syncope with associated bradycardia reproduced by tilt table testing with or without isoproterenol or other provocative measures (temporary pacing with a 2nd provocative test may determine benefit of pacemaker)
- pacing unnecessary
- hyperactive cardiopulmonary response to carotid artery stimulation in the absence of symptoms
- vague symptoms, such as dizziness &/or lightheadedness, with a hyperactive cardioinhibitory response to carotid sinus stimulation
- recurrent syncope, lightheadedness, or dizziness in the absence of a cardioinhibitory response to carotid sinus stimulation
- * heart block at the His bundle associated with bilateral bundle branch block
More General Terms
References
Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1017
