Biomedical Engineering Reference
In-Depth Information
AV block within or below the His-Purkinje system after
ST-segment elevation myocardial infarction
Transient, advanced second- or third-degree infranodal
•
Congenital third-degree AV block beyond the first year of
life with an average heart rate less than 50 beats/min,
abrupt pauses in ventricular rate that are two or three
times the basic cycle length, or associated with symptoms
due to chronotropic incompetence
Sinus bradycardia with complex congenital heart disease
•
AV block and associated bundle branch block. If the site
of block is uncertain, electrophysiologic testing may be
necessary
Persistent and symptomatic second- or third-degree AV
•
•
with a resting heart rate less than 40 beats/min or pauses
in ventricular rate longer than 3 s
Patients with congenital heart disease and impaired hemo-
block
•
Recommendations for Permanent Pacing in Chronic
Bifascicular Block
Advanced second-degree AV block or intermittent third-
dynamics due to sinus bradycardia or loss of AV synchrony
Unexplained syncope in the patient with prior congenital
•
•
heart surgery complicated by a transient complete heart
block with residual fascicular block after a careful evalu-
ation to exclude other causes of syncope
degree AV block
Type II second-degree AV block
•
•
Alternating bundle branch block
•
Syncope not demonstrated to be due to AV block when
Recommendations for Pacing After Cardiac Transplantation
Persistent inappropriate or symptomatic bradycardia not
other likely causes have been excluded, specifically VT
Incidental finding on electrophysiologic testing of a mark-
•
•
expected to resolve and for other class I indications for
permanent pacing
edly prolonged HV interval (
³
100 ms) in asymptomatic
patients
Incidental finding on electrophysiological study of
•
Recommendations for Pacing to Prevent Tachycardia
Sustained, pause-dependent VT, with or without QT
pacing-induced
infra-His
block
that
is
not
•
physiological
prolongation
High-risk patients with congenital long-QT syndrome
•
Recommendations for Permanent Pacing in Hypersensitive
Carotid Sinus Syndrome and Neurocardiogenic Syncope
Recurrent syncope caused by spontaneously occurring
Recommendations for Pacing in Patients with Hypertrophic
Cardiomyopathy
SND or AV block in patients with hypertrophic cardio-
•
carotid sinus stimulation and carotid sinus pressure that
induces ventricular asystole of more than 3 s
Syncope without clear, provocative events and with a
•
myopathy as described previously (see “Recommendations
for Permanent Pacing in Sinus Node Dysfunction” and
“Recommendations for Acquired Atrioventricular Block
in Adults”)
•
hypersensitive cardioinhibitory response of 3 s or
longer
Recommendations for Permanent Pacing in Children,
Adolescents, and Patients with Congenital Heart Disease
Advanced second- or third-degree AV block associated
6.1.1
Contraindications
•
with symptomatic bradycardia, ventricular dysfunction,
or low cardiac output
SND with correlation of symptoms during age-inappro-
Pacemakers are generally contraindicated for the following
applications [ 32 ] :
ICD (especially when use of a unipolar pacemaker lead is
•
•
priate bradycardia; the definition of bradycardia varies
with the patient's age and expected heart rate
Postoperative, advanced second- or third-degree AV block
intended; it may cause unwanted delivery or inhibition of
ICD therapy).
Use of the MV sensor for patients with an ICD.
•
•
that is not expected to resolve or that persists at least 7
days after cardiac surgery
Congenital third-degree AV block with a wide QRS
•
Use of the MV sensor in patients with only unipolar leads
because a bipolar lead is required in either the atrium or
the ventricle for detection of MV.
Single-chamber atrial pacing in patients with impaired
•
escape rhythm, complex ventricular ectopy, or ventricular
dysfunction
Congenital third-degree AV block in the infant with a ven-
•
AV nodal conduction.
Atrial tracking modes for patients with chronic refractory
•
•
tricular rate less than 55 beats/min or with congenital heart
disease and a ventricular rate less than 70 beats/min
Patients with congenital heart disease and sinus bradycar-
atrial tachycardia (atrial fibrillation or flutter), which
might trigger ventricular pacing.
Dual-chamber and single-chamber atrial pacing in patients
•
•
dia for the prevention of recurrent episodes of intra-atrial
reentrant tachycardia; SND may be intrinsic or secondary
to antiarrhythmic treatment
with chronic refractory atrial tachycardia.
Asynchronous pacing in the presence (or likelihood) of
•
competition between paced and intrinsic rhythms.
