ACC GUIDELINES Bundle (free trial)

Diagnosis and Treatment Treatment ÎÎPermanent pacemaker implantation is indicated for: •  advanced second- or third-degree AV block associated with symptomatic bradycardia, ventricular dysfunction, or low cardiac output. (I-C) •  SND with correlation of symptoms during age-inappropriate bradycardia. (I-B) The definition of bradycardia varies with the patient's age and expected heart rate. •  postoperative advanced second- or third-degree AV block that is not expected to resolve or that persists ≥7 days after cardiac surgery. (I-B) •  congenital third-degree AV block with a wide QRS escape rhythm, complex ventricular ectopy, or ventricular dysfunction. (I-B) •  congenital third-degree AV block in the infant with a ventricular rate <55 bpm or with congenital heart disease and a ventricular rate <70 bpm. (I-C) ÎÎPermanent pacemaker implantation is reasonable for: •  patients with congenital heart disease and sinus bradycardia for the prevention of recurrent episodes of intra-atrial reentrant tachycardia. SND may be intrinsic or secondary to antiarrhythmic treatment. (IIa-C) •  congenital third-degree AV block beyond the first year of life with an average heart rate <50 bpm, abrupt pauses in ventricular rate that are 2 or 3 times the basic cycle length, or associated with symptoms due to chronotropic incompetence. (IIa-B) •  sinus bradycardia with complex congenital heart disease with a resting heart rate   <40 bpm or pauses in ventricular rate >3 seconds. (IIa-C) •  patients with congenital heart disease and impaired hemodynamics due to sinus bradycardia or loss of AV synchrony. (IIa-C) •  unexplained syncope in the patient with prior congenital heart surgery complicated by transient complete heart block with residual fascicular block after a careful evaluation to exclude other causes of syncope. (IIa-B) ÎÎPermanent pacemaker implantation may be considered for: •  transient postoperative third-degree AV block that reverts to sinus rhythm with residual bifascicular block. (IIb-C) •  congenital third-degree AV block in asymptomatic children or adolescents with an acceptable rate, a narrow QRS complex, and normal ventricular function. (IIb-B) •  asymptomatic sinus bradycardia after biventricular repair of congenital heart disease with a resting heart rate <40 bpm or pauses in ventricular rate >3 seconds. (IIb-C) ÎÎPermanent pacemaker implantation is NOT indicated for: •  transient postoperative AV block with return of normal AV conduction in the otherwise asymptomatic patient. (III-B) •  asymptomatic bifascicular block with or without first-degree AV block after surgery for congenital heart disease in the absence of prior transient complete AV block. (III-C) •  asymptomatic type I second-degree AV block. (III-C) •  asymptomatic sinus bradycardia with the longest relative risk interval <3 seconds and a minimum heart rate >40 bpm. (III-C) 10

• Cover