Permanent Pacing After the Acute Phase of Myocardial
Infarction (MI)
Key Points
ÎÎIndications for permanent pacing after MI in patients experiencing AV
block are related in large measure to the presence of intraventricular
conduction defects.
ÎÎThe criteria for patients with MI and AV block do not necessarily
depend on the presence of symptoms. Furthermore, the requirement
for temporary pacing in acute myocardial infarction (AMI) does not by
itself constitute an indication for permanent pacing.
Treatment
ÎÎPermanent ventricular pacing is indicated for:
• persistent second-degree AV block in the His-Purkinje system with alternating
bundle-branch block or third-degree AV block within or below the His-Purkinje
system after ST-segment elevation MI. (I-B)
• transient advanced second- or third-degree infranodal AV block and associated
bundle-branch block. If the site of block is uncertain, an electrophysiological study
may be necessary. (I-B)
• persistent and symptomatic second- or third-degree AV block. (I-C)
ÎÎPermanent ventricular pacing may be considered for:
• persistent second- or third-degree AV block at the AV node level, even in the
absence of symptoms. (IIb-B)
ÎÎPermanent ventricular pacing is NOT indicated for:
• transient AV block in the absence of intraventricular conduction defects. (III-B)
• transient AV block in the presence of isolated left anterior fascicular block. (III-B)
• new bundle-branch block or fascicular block in the absence of AV block. (III-B)
• persistent asymptomatic first-degree AV block in the presence of bundle-branch or
fascicular block. (III-B)
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