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308 PART 3: Cardiovascular Disorders

TABLE 37-5 Indications for Temporary Transvenous Pacing in Acute infarction: randomised placebo-controlled trial. Lancet. 2005;
Myocardial Infarction 366:1622-1632.
Class I • Drakos SG, Uriel N. Spotlight on cardiogenic shock therapies in
Asystole the era of mechanical circulatory support. Curr Opin Cardiol.
2014;29:241-243.
Complete heart block
• Fraker TD Jr, Fihn SD, Gibbons RJ, et al. 2007 chronic angina
Mobitz type II second-degree heart block focused update of the ACC/AHA 2002 Guidelines for the man-
Bilateral bundle branch block (alternating BBB or RBBB with alternating LAFB/LPHB) agement of patients with chronic stable angina: a report of the
New bifascicular block (RBBB with LAFB or LPHB, or LBBB) with first-degree AV block American College of Cardiology/American Heart Association
Task Force on Practice Guidelines Writing Group to develop the
Symptomatic bradycardia
focused update of the 2002 Guidelines for the management of
Class IIa patients with chronic stable angina. Circulation. 2007;116:2762-2772.
New bifascicular block • Hochman JS, Sleeper LA, White HD, et al. One-year survival
RBBB with first-degree AV block following early revascularization for cardiogenic shock. JAMA.
2001;285:190-192.
Incessant V T, for atrial or ventricular overdrive pacing
• Hollenberg SM. Recognition and treatment of cardiogenic shock.
Recurrent sinus pauses (>3 seconds) not responsive to atropine
Semin Respir Crit Care Med. 2004;25:661-671.
New LBBB a
• Jaffe AS, Babuin L, Apple FS. Biomarkers in acute cardiac disease:
Class IIb the present and the future. J Am Coll Cardiol. 2006;48:1-11.
Bifascicular block of indeterminate age • Keeley EC, Boura JA, Grines CL. Primary angioplasty versus
New isolated RBBB intravenous thrombolytic therapy for acute myocardial infarc-
tion: a quantitative review of 23 randomised trials. Lancet.
Class III
2003;361:13-20.
First-degree AV block
• Kushner FG, Hand M, Smith SC Jr, et al. 2009 Focused Updates:
Type I second-degree AV block ACC/AHA Guidelines for the Management of Patients With
Accelerated idioventricular rhythm ST-Elevation Myocardial Infarction (Updating the 2004 Guideline
and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on
Known preexisting BBB or fascicular block
Percutaneous Coronary Intervention (Updating the 2005 Guideline
AV, atrioventricular; BBB, bundle branch block; LAFB, left anterior fascicular block; LBBB, left bundle branch and 2007 Focused Update): a report of the American College of
block; LPFB, left posterior fascicular block; RBBB, right bundle branch block; VT, ventricular tachycardia. Cardiology Foundation/American Heart Association Task Force on
a Controversial Practice Guidelines. Circulation. 2009;120:2271-2306.
Rating of recommendations: • Mehran R, Brodie B, Cox DA, et al. The Harmonizing Outcomes
Class I: General agreement treatment is effective. with RevasculariZatiON and Stents in Acute Myocardial Infarction
(HORIZONS-AMI) Trial: study design and rationale. Am Heart J.
Class IIa: Weight of evidence favors efficacy.
2008;156:44-56.
Class IIb: Efficacy less well established by evidence or opinion.
• Thiele H, Zeymer U, Neumann F-J, et al. Intra-aortic balloon
Class III: General agreement treatment is not useful and in some cases may be harmful.
counterpulsation in acute myocardial infarction complicated by
Data from Ryan et al. ACC/AHA guidelines for the management of patients with acute myocardial infarc- cardiogenic shock (IABP-SHOCK II): final 12 month results of a
tion. J Am Coll Cardiol. September 1999;34(3):890-911. randomised, open-label trial. Lancet. 2013;382:1638-1645.
tachycardia or deceleration to asystole. It is this characteristic of subsid-
iary ventricular pacemakers that guides the indication for prophylactic
placement of temporary transvenous pacing in acute MI. Table 37-5 gives REFERENCES
these indications, which are based on studies documenting the progres-
sion to high-grade AV block when the indicated conduction disturbances Complete references available online at www.mhprofessional.com/hall
are present. Any bradyarrhythmia unresponsive to atropine that results in
hemodynamic compromise requires pacing.

CHAPTER Acute Right Heart

KEY REFERENCES 38 Syndromes
• Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 Ivor S. Douglas
guidelines for the management of patients with unstable angina/
non ST-elevation myocardial infarction: a report of the American
College of Cardiology/American Heart Association Task Force on KEY POINTS
Practice Guidelines. J Am Coll Cardiol. 2007;50.
• Chen ZM, Jiang LX, Chen YP, et al. Addition of clopidogrel to • Right heart syndromes (RHS) as a cause of hemodynamic instabil-
aspirin in 45,852 patients with acute myocardial infarction: ran- ity and shock are less common than left heart dysfunction, but
domised placebo-controlled trial. Lancet. 2005;366:1607-1621. recognizing them requires a high level of vigilance.
• Chen ZM, Pan HC, Chen YP, et al. Early intravenous then • RHS result from a combination of pressure or volume overload
oral metoprolol in 45,852 patients with acute myocardial and impaired RV contractility. Progression to acute cor pulmonale (the

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