Indications for Pacing

Indications for Pacing - Circulation 2002;106:2145-2161...

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Unformatted text preview: Circulation 2002;106:2145-2161 Circulation 2002;106:2145-2161 Indications for Cardiac Pacing Indications for Cardiac Pacing Adapted from the ACC/AHA/NASPE Guidelines Adapted from the ACC/AHA/NASPE Guidelines for Implantation of Cardiac Pacemakers for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices and Antiarrhythmia Devices DR.M.MOHSINHOSSAIN MB BS, MD(Med),FCPS(Card), Assistant Professor of Cardiology NICVD, Dhaka Guidelines for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices Guidelines for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices • 1984 – Original pacemaker guidelines published • 1991 – Guidelines revised and implantable cardioverter defibrillators (ICDs) added • 1998 – Guidelines revised • 2002 - ACC/AHA/NASPE guideline update for implantation of cardiac pacemakers and antiarrhythmia devices Task Force on Practice Guidelines Task Force on Practice Guidelines (Committee on Pacemaker Implantation) (Committee on Pacemaker Implantation) ACC/AHA/NASPE Task Force Committee • Role : Develop and revise important cardiovascular practice guidelines • Includes: – Experts from ACC, AHA and NASPE – Representatives from: ACP, STS, and NASPE – University-affiliated and practicing physicians • Process: A formal literature review and evaluation of evidence • Procedures and treatments are classified by usefulness and efficacy Classifications of Procedures and Treatments Class I: Conditions for which there is evidence and/or general agreement that a procedure or treatment is beneficial, useful, and effective Class II: Conditions for which there is conflicting evidence and/or divergence of opinion regarding usefulness and/or efficacy of a procedure or treatment IIa: Weight of evidence in favor of benefit IIb: Usefulness/efficacy less well established by evidence/opinion Class III: Conditions for which there is evidence and/or general agreement that a procedure/treatment is not useful/effective and in some cases may be harmful Pacing for Acquired AV Block in Adults AV Block • First-degree AV block • Second-degree AV block – Mobitz type I – Mobitz type II • Third-degree AV block • Bifascicular and trifascicular block First-Degree AV Block • AV conduction is delayed, and the PR interval is prolonged (> 200 ms or .2 seconds) – Rate = 79 bpm – PR interval = 340 ms (.34 seconds) 340 ms Second-Degree AV Block – Mobitz I (Wenckebach) • Progressive prolongation of the PR interval until a ventricular beat is dropped – Ventricular rate = irregular – Atrial rate = 90 bpm – PR interval = progressively longer until a P-wave fails to conduct 200 360 400 ms ms ms No QRS Second-Degree AV Block – Mobitz II • Regularly dropped ventricular beats – 2:1 block (2 P waves to 1 QRS complex) – Ventricular rate = 60 bpm – Atrial rate = 110 bpm P P QRS Third-Degree AV Block • No impulse conduction from the atria to the ventricles – Ventricular rate = 37 bpm – Atrial rate = 130 bpm – PR interval = variable Pacing for Acquired AV Block in Adults...
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This note was uploaded on 12/27/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Indications for Pacing - Circulation 2002;106:2145-2161...

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