TEMPORARY PACE

MAKER DURATION
Widi Nugraha Hadian

 Temporary transvenous pacing shall not be used routinely.

Temporary transvenous pacing should be limited to case :
1. High degree AV block without escape rhytm
2. Life threatening bradyarrhytmias, such as in :

a. Acute Myocardial Infarction

b During Interventional Procedures (ex; PCI)
c. Drug Toxicity
d. Concomitant systemic infection

Sumber : ESC Cardiac Pacing and Cardiac

Resynchronization Therapy 2013

 If the indications for permanent pacing are established,

every effort should be made to implant a permanent

Pacemaker as soon as possible.

Sumber : ESC Cardiac Pacing and Cardiac

Resynchronization Therapy 2013

Pacing in Acute Myocardial Infarction

AV block complicating acute myocardial infarction most

often resolves itself spontaneously within 2-7 days.

with only 9% patients requiring permanent pacing.

Permanent cardiac pacing does not influence the

prognosis of these patients and therefore is not

recommended.
Sumber : ESC Cardiac Pacing and Cardiac
Resynchronization Therapy 2013

Results :
Patients with fibrinolytic therapy :
Median Duration of the AV block was 45 minutes (range : 5 minutes - 48
hours)
Patients without fibrinolytic therapy :
Median duration of the AV block was 24 hours (range : 15 minutes 9 days)
Conclusion :
Duration of the block seems to be shorter in patients treated with fibrinolytic
therapy.

Indication For Permanent Pacing in MI

Sumber : ESC Cardiac Pacing and

Cardiac Resynchronization Therapy
2013

Indication For Permanent Pacing in MI

Sumber : ESC
Cardiac Pacing
and Cardiac
Resynchronization
Therapy 2013

Indication For Permanent Pacing in MI

Sumber :
ESC Cardiac
Pacing and
Cardiac
Resynchronization
Therapy 2013

Indication For Permanent Pacing in MI

Class I
Persistent second-degree AV block in the His Purkinje system

with bundle branch block or third-degree AV block within or

below the HisPurkinje system after acute MI. (Level of
evidence: B.)
Transient advanced (second- or third-degree) infranodal AV

block and associated bundle branch block. (Level of evidence:

B.)
Persistent and symptomatic second or third-degree AV block.

(Level of evidence: C.)

Sumber : ACC/AHA/HRS 2008 Guidelines for Device

Based Therapy of Cardiac Rhytm Abnormality

Class IIb
Permanent ventricular pacing may be considered for

persistent second or third degree AV block at the AV

node level, even in the absence of symptoms. (Level
of Evidence: B) (58)

Sumber : ACC/AHA/HRS 2008 Guidelines for

Device Based Therapy of Cardiac Rhytm
Abnormality

Commonly used medication that may cause sinus

node dysfunction or Atrioventricular Block
Digitalis Antihypertensive Agents (clonidine,methyldopa, guanethidine)
Beta Adrenegic Blocker (inderal, metoprolol, nadolol, ateprolol)
Calcium Channel Blockers (Verapamil, Diltiazem)
Type 1 A antyarrhytmia drugs (Quinidine, procainamide)
Type 1 C antiarrhytmic drugs (flecainide, Propafenone)
Type III antyarrhytmic drugs (amiodarone, sotalol)
Psychotropic Medication
Sumber : Indications for permanent and temporary
cardiac pacing
Robert W Peters, Pugazhendhi Vijayaraman, Kenneth A
Ellenbogen

Pacing during Cardiac Catheterization

Cardiac catheterization may induce transient RBBB

blocks lasts for seconds or minutes, but can

occasionally last for hours or days.

Sumber : Indications for permanent

and temporary cardiac pacing
Robert W Peters, Pugazhendhi
Vijayaraman, Kenneth A Ellenbogen

 Low

rate of infection during the first week of

transvenous temporary pacing.

Longer duration of temporary pacing complication rate

increase.

Routine use of prophylactic antibiotics is not necessary

unless:
There is a sign of infection
Pacing is prolonged (>7 days)
Femoral access is used

TERIMA KASIH

Condition Indicated For Permanent Pacing

Sinus Node Dysfunction
Acquired Atrioventricular Block in Adults
Chronic Bifasicular Block
Atrioventricular Block Associated With Acute Myocardial

Infarction
Hypersensitive Carotid Sinus Syndrome and
Neurocardiogenic Syndrome

Sumber : ACC/AHA/HRS 2008

Guidelines for Device Based
Therapy of Cardiac Rhytm
Abnormality

Sumber : Management of Cardiac Arrhytmias - Yan GH