The indications for pacemakers are mainly the following.
i. Sinus node malfunction.
ii. acquired atrioventricular block.
III. chronic double bundle branch or triple branch block.
Carotid sinus allergy syndrome and neurally mediated syncope; Zhang Tao, Department of Cardiology, The First Affiliated Hospital of Tsinghua University
V. Acute infarct-related atrioventricular block.
VI. Acute infarct-related sinus node malfunction.
Sinus node dysfunction
I. Class I indications
1. Symptomatic sinus bradycardia
l sick sinus syndrome – double node lesion
l Sinus syndrome-associated cerebral embolism
l Slow and fast syndrome
DD symptomatic sinus bradycardia caused by a drug that must be applied
l Betalactam – symptomatic bradycardia due to control of rapid ventricular rate in atrial fibrillation.
l Amiodarone, digoxin, betalactam – treatment of symptomatic sinus bradycardia due to heart failure and tachyarrhythmia
2. Sinus bradycardia due to sinus node malfunction
l Sick sinus syndrome, coronary artery disease – sinus node malfunction
Sinus node autoregulation is normal, but the sinus node is not functioning properly
l Dynamic electrocardiogram confirmed sinus node dysfunction
II. Class IIa indications
1. Sinus node malfunction, heart rate ≤ 40 bpm, bradycardia symptoms, not confirmed to be symptom related
l Sinus bradycardia occurring during sleep, escape rhythm ≤ 40bpm
l Transient palpitations, dizziness unable to confirm symptoms associated with bradycardia
2. unexplained syncope with sinus node malfunction or electrophysiological examination reveals sinus node malfunction
l Esophageal atrial pacing confirmed sinus node malfunction
Sinus node malfunction induced by coronary artery spasm detected by dynamic ECG
Acquired atrioventricular block
I. Class I indications
1. Third degree and high degree atrioventricular block at any block site with
DD symptomatic bradycardia
l third-degree AV block resulting in increased heart failure symptoms
l Myocarditis third degree AV block with syncope
l Intermittent third-degree AV block with syncope confirmed by implantable Holter
l Third-degree AV block with ventricular escape rhythm
DD may cause symptoms with drugs required for the treatment of other diseases
Intermittent third-degree AV block with syncope associated with betalactone
DD without symptoms, with proven ventricular arrest for ≥3 s or a fugitive heart rate <40 bpm in the awake state
l Atrial fibrillation with second atrioventricular block resulting in ventricular arrest for ≥3s
l 12 years of persistent asymptomatic first- and second-degree AV block evolving into asymptomatic third-degree AV block
After DD atrioventricular junctional zone ablation
l Slow atrioventricular node ablation combined with almost complete atrioventricular block
2. Second-degree AV block with symptomatic bradycardia
l Symptomatic second-degree AV block with ventricular escape
l Symptomatic first-degree combined with second-degree type I atrioventricular block
II. Class IIa indications
1, asymptomatic third-degree AV block at any block site with mean ventricular rate ≥ 40 bpm during waking hours
l coronary artery disease for many years combined with asymptomatic third-degree atrioventricular block ventricular rate ≥ 40bpm
l Asymptomatic third-degree AV node block
2, asymptomatic second degree type II AV block with narrow QRS waves
l asymptomatic second degree type II AV block with narrow QRS
3.Asymptomatic second degree type I AV block with block site within or under the bundle of Hitchcock
l asymptomatic second-degree type I AV block with Hitchcock tract block
4. First- or second-degree AV block with pacemaker-like syndrome-related clinical manifestations
l Acute infarction with persistent prolonged PR interval syndrome
Acute myocarditis with persistent prolonged PR interval syndrome
Chronic double bundle branch or triple branch block
I. Class I indications
1. Double or triple branch block with intermittent third degree atrioventricular block
l Asymptomatic third-branch block to third-degree AV block
l Three-branch block with syncope
Frequency-dependent bifurcation block, intermittent third-branch block with syncope
2. Bifurcation or third-branch block with second-degree type II atrioventricular block
First-degree AV block with right bundle branch block with symptomatic persistent second-degree 2:1 AV block
l First-degree AV block with right bundle branch block with symptomatic intermittent second-degree 2:1 AV block
l asymptomatic second degree 2:1 AV block with right bundle branch block
3.Alternating bilateral bundle branch block
l coronary artery disease with alternating bilateral bundle branch block
II. Class IIa indications
1. Although syncope is not confirmed to be caused by atrioventricular block, syncope due to other causes (especially ventricular tachycardia) can be excluded
First-degree AV block with right bundle-branch block with dynamic electrocardiogram to exclude ventricular tachycardia
l Second-degree type I AV block with left bundle branch block with dynamic ECG to exclude ventricular tachycardia
2. Prolonged HV interval (≥100ms) on electrophysiological examination despite the absence of clinical symptoms
l HV interval Wen prolongation ≥100ms ……… …additional medical history is required
3. Non-physiological block below the Hitchcock bundle induced by atrial pacing during electrophysiological examination
l primary atrioventricular block Lev’s disease
l organic heart disease with bundle branch block
Carotid sinus allergy syndrome and neurally mediated syncope
I. Class I indications
1. Slight pressure on the carotid sinus can lead to ventricular arrest for more than 3s
Atrioventricular block with 4.5s of cardiac arrest due to carotid sinus compression test
4.3s of sinus arrest due to carotid sinus compression test
II. Class IIa indications
1. Recurrent syncope of unknown origin, with abnormally increased sensitivity of the carotid sinus and cardiac depression reflex
3.04s of cardiac arrest due to carotid artery compression test
2.Recurrent neuro- cardiac syncope with spontaneous or tilt test induced bradycardia
l Self-standing tilt test resulting in heart rate slowing by 36 bpm
l 10.16s of cardiac arrest due to upright tilt test
Atrioventricular block associated with acute heart attack
I. Class I indications
1. Persistent double bundle branch block or second or third degree atrioventricular block below the Hitchcock bundle after acute infarction
Persistent first- and second-degree type I AV block with right bundle branch block
l Persistent second-degree AV block with right bundle branch block
2. Transient high degree second- or third-degree AV node block with bundle branch block below the AV node. If the site of block is uncertain, electrophysiological examination should be performed
3, persistent symptomatic second- or third-degree atrioventricular block
l Acute anterior wall infarction with persistent symptomatic second-degree type I atrioventricular block
Sinus node malfunction associated with acute infarction
Acute interstitial infarction with complete left bundle branch block, sinus arrest with ventricular escape rhythm
Acute anterior and inferior wall infarction with second degree type II sinus block with double bundle branch block