Permanent cardiac pacing: Overview of devices and indications
- David L Hayes, MD
David L Hayes, MD
- Professor of Medicine
- Mayo Medical School
Cardiac pacemakers are effective treatments for a variety of bradyarrhythmias. By providing an appropriate heart rate and heart rate response, cardiac pacing can reestablish effective circulation and more normal hemodynamics that are compromised by a slow heart rate.
This topic will present a broad review of the role of cardiac pacing in a variety of settings. The management of the specific disorders is discussed separately as is a description of the different types of pacemakers and pacing modes. (See "Treatment of the sick sinus syndrome" and "Third degree (complete) atrioventricular block" and "Second degree atrioventricular block: Mobitz type II" and "Modes of cardiac pacing: Nomenclature and selection".)
Despite the myriad of clinical situations in which permanent pacing is considered, most management decisions regarding permanent pacemaker implantation are driven by the following clinical factors:
●The association of symptoms with a bradyarrhythmia
●The location of the conduction abnormality
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- GENERAL PRINCIPLES
- Location of conduction abnormality
- Reversible causes
- Concurrent ICD
- TYPES OF PERMANENT PACEMAKER SYSTEMS
- Pulse generators
- Transvenous systems
- Epicardial systems
- Leadless systems
- PROFESSIONAL SOCIETY GUIDELINES
- COMMON INDICATIONS
- Sinus node dysfunction
- - Class I
- - Class II
- Acquired AV block
- - Class I
- - Class II
- Post myocardial infarction
- Neurally-mediated syncope
- OTHER INDICATIONS
- Congenital complete heart block
- Neuromuscular diseases
- Long QT syndrome
- - Bradycardia-induced ventricular arrhythmias
- Hypertrophic cardiomyopathy
- Heart failure
- CLASS III: PACING NOT INDICATED
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS