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 "Sick sinus syndrome: Treatment" 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
- Auricchio A, Delnoy PP, Butter C, et al. Feasibility, safety, and short-term outcome of leadless ultrasound-based endocardial left ventricular resynchronization in heart failure patients: results of the wireless stimulation endocardially for CRT (WiSE-CRT) study. Europace 2014; 16:681.
- Reddy VY, Knops RE, Sperzel J, et al. Permanent leadless cardiac pacing: results of the LEADLESS trial. Circulation 2014; 129:1466.
- Knops RE, Tjong FV, Neuzil P, et al. Chronic performance of a leadless cardiac pacemaker: 1-year follow-up of the LEADLESS trial. J Am Coll Cardiol 2015; 65:1497.
- Ritter P, Duray GZ, Steinwender C, et al. Early performance of a miniaturized leadless cardiac pacemaker: the Micra Transcatheter Pacing Study. Eur Heart J 2015; 36:2510.
- Reddy VY, Exner DV, Cantillon DJ, et al. Percutaneous Implantation of an Entirely Intracardiac Leadless Pacemaker. N Engl J Med 2015; 373:1125.
- Miller MA, Neuzil P, Dukkipati SR, Reddy VY. Leadless Cardiac Pacemakers: Back to the Future. J Am Coll Cardiol 2015; 66:1179.
- Reynolds D, Duray GZ, Omar R, et al. A Leadless Intracardiac Transcatheter Pacing System. N Engl J Med 2016; 374:533.
- Reddy VY, Miller MA, Neuzil P, et al. Cardiac Resynchronization Therapy With Wireless Left Ventricular Endocardial Pacing: The SELECT-LV Study. J Am Coll Cardiol 2017; 69:2119.
- Sperzel J, Burri H, Gras D, et al. State of the art of leadless pacing. Europace 2015; 17:1508.
- Piccini JP, Stromberg K, Jackson KP, et al. Long-term outcomes in leadless Micra transcatheter pacemakers with elevated thresholds at implantation: Results from the Micra Transcatheter Pacing System Global Clinical Trial. Heart Rhythm 2017; 14:685.
- Duray GZ, Ritter P, El-Chami M, et al. Long-term performance of a transcatheter pacing system: 12-Month results from the Micra Transcatheter Pacing Study. Heart Rhythm 2017; 14:702.
- Tjong FV, Stam OC, van der Wal AC, et al. Postmortem Histopathological Examination of a Leadless Pacemaker Shows Partial Encapsulation After 19 Months. Circ Arrhythm Electrophysiol 2015; 8:1293.
- http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm494390.htm (Accessed on April 08, 2016).
- El-Chami MF, Merchant FM, Leon AR. Leadless Pacemakers. Am J Cardiol 2017; 119:145.
- Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:e350.
- Tracy CM, Epstein AE, Darbar D, et al. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. [corrected]. Circulation 2012; 126:1784.
- Brignole M, Auricchio A, Baron-Esquivias G, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J 2013; 34:2281.
- Recommendations for pacemaker prescription for symptomatic bradycardia. Report of a working party of the British Pacing and Electrophysiology Group. Br Heart J 1991; 66:185.
- Zeltser D, Justo D, Halkin A, et al. Drug-induced atrioventricular block: prognosis after discontinuation of the culprit drug. J Am Coll Cardiol 2004; 44:105.
- European Heart Rhythm Association, Heart Rhythm Society, Zipes DP, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 2006; 48:e247.
- Groh WJ. Arrhythmias in the muscular dystrophies. Heart Rhythm 2012; 9:1890.
- Authors/Task Force members, Elliott PM, Anastasakis A, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 2014; 35:2733.
- Gersh BJ, Maron BJ, Bonow RO, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124:2761.
- GENERAL PRINCIPLES
- Location of conduction abnormality
- Reversible causes
- Concurrent ICD
- TYPES OF PERMANENT PACEMAKER SYSTEMS
- Pulse generators
- Transvenous systems
- Epicardial systems
- Leadless systems
- 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
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS