Page 84 - Critical Care Notes

4223_Tab02_045-106 29/08/14 10:00 AM Page 78

CV

Permanent Pacemakers
Permanent pacing is performed for the resolution of nontemporary conduction
disorders, including complete heart block and sick sinus syndrome. Permanent
pacemakers are usually powered by a lithium battery and have an average life
span of 10 yr.
Indications
■ Class I: The procedure should be performed.
■ Class IIa: It is reasonable to perform the procedure, but additional studies
with focused objectives are needed.
■ Class IIb: The procedure may be considered, but additional studies with
broad objectives are needed.
■ Class III: The procedure should not be performed; it is not helpful and may
be harmful.
In 2008 the American College of Cardiology (ACC), the American Heart
Association (AHA), and the Heart Rhythm Society (HRS), jointly published guide-
lines for pacemaker insertion indications:
■ Class I indications
■ Sinus node dysfunction
■ Acquired atrioventricular block in adults
■ Chronic bifascicular block
■ After acute MI
■ Hypersensitive carotid sinus syndrome and neurocardiogenic syncope
■ After cardiac transplantation
■ Pacing to prevent tachycardia
■ Congenital heart disease
■ Class IIa indications
■ Sinus node dysfunction
■ Acquired atrioventricular block
■ Hypersensitive carotid sinus syndrome and neurocardiogenic syncope
■ Congenital heart disease
■ Pacing to prevent tachycardia
■ Permanent pacemakers that automatically detect and pace to terminate
tachycardia
■ Class IIb indications
■ Sinus node dysfunction
■ Acquired atrioventricular block in adults
■ Chronic bifascicular block
■ After acute MI
■ Hypersensitive carotid sinus syndrome and neurocardiogenic syncope
■ After cardiac transplant
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