When is pacemaker placement indicated?

Updated: Feb 13, 2017
  • Author: Daniel M Beyerbach, MD, PhD; Chief Editor: Jeffrey N Rottman, MD  more...
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Answer

Answer

The most certain indications for permanent pacing include the following:

  • Symptomatic bradycardia due to sinus node dysfunction (sick sinus syndrome)

  • Symptomatic chronotropic incompetence

  • Symptomatic sinus bradycardia due to necessary drug therapy for other medical conditions, such as atrial fibrillation or coronary artery disease

  • Symptomatic AV block

  • Symptomatic bradycardia due to complete heart block or second-degree AV block or when ventricular arrhythmias are presumed to arise from AV block

  • Symptomatic bradycardia due to complete heart block or second-degree AV block that is due to necessary drug therapy for another medical condition

  • Second- or third-degree AV block in asymptomatic awake patients in sinus rhythm resulting in periods of asystole longer than 3.0 seconds or ventricular rates less than 40 beats per minute

  • Second -or third-degree AV block in asymptomatic awake patients in atrial fibrillation resulting in pauses of at least 5 seconds

  • To facilitate AV node ablation

  • Advanced second- or third-degree AV block associated with neuromuscular diseases such as myotonic dystrophy, Kearns-Sayer syndrome, Erb dystrophy (limb-girdle muscular dystrophy), and peroneal muscular atrophy

  • Second- or third-degree AV block during exercise in the absence of myocardial ischemia

  • Recurrent syncope caused by spontaneously occurring carotid sinus stimulation and demonstrable ventricular pauses of greater than 3 seconds with purposeful carotid sinus pressure

  • Cardiac resynchronization therapy with biventricular pacing

In the setting of chronic bifascicular block, permanent pacing is indicated for:

  • Advanced second-degree AV block or intermittent third-degree AV block

  • Type II second-degree AV block

  • Alternating bundle branch block

Temporary emergency pacing is indicated for therapy of significant and hemodynamically unstable bradyarrhythmias and for prevention of bradycardia-dependent malignant arrhythmias.


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