What are the ACC-AHA-HRS guidelines for permanent pacemaker implantation in the treatment of atrioventricular (AV) blocks?

Updated: Jul 05, 2018
  • Author: Akanksha Agrawal, MBBS; Chief Editor: Jeffrey N Rottman, MD  more...
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Permanent pacemaker implantation is indicated for third-degree and advanced second-degree AV block at any anatomic level [21] :

  • Associated with bradycardia with symptoms (including heart failure) or ventricular arrhythmias presumed to be due to AV block
  • Associated with arrhythmias and other medical conditions that require drug therapy that results in symptomatic bradycardia
  • In awake, symptom-free patients in sinus rhythm with documented periods of asystole 3 seconds or longer or any escape rate below 40 beats/min, or with an escape rhythm that is below the AVN
  • In awake, symptom-free patients with atrial fibrillation and bradycardia with one or more pauses of at least 5 seconds or longer
  • After catheter ablation of the AV junction
  • Associated with postoperative AV block that is not expected to resolve after cardiac surgery
  • Associated with neuromuscular diseases with AV block (eg, myotonic muscular dystrophy, Kearns-Sayre syndrome, Erb dystrophy [limb-girdle muscular dystrophy], and peroneal muscular atrophy), with or without symptoms

Permanent pacemaker implantation is indicated for second-degree AV block with associated symptomatic bradycardia, regardless of type or site of the block.

Permanent pacemaker implantation is indicated for asymptomatic persistent third-degree AV block at any anatomic site with average awake ventricular rates of 40 beats/min or faster if cardiomegaly or left ventricular dysfunction is present or if the site of the block is below the AVN.

Permanent pacemaker implantation is indicated for second- or third-degree AV block during exercise in the absence of myocardial ischemia.

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