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Indications for Permanent Pacing in Acquired Atrioventricular Block in Adults Class 1 PACEMAKER IMPLANTATION 6 1. Third-egree AV block at any anatomic level, aso with any one of the following conditions: ¢. Documented periods of asystole 23.0 seconds (25) a. Bradscardia with symptoms presumed to be due to Cor any escape rate <40 beats per minute (bpm) in AV block. (Level of evidence: ©) awake, symptom-free pat 7). (Leel of ev b, ias and other medial conditions that re- dence: BC) tle bradycardia After catheter ablation of the AV juneton. (Level of evidence: B,C) There are no trials to assess outcome without pacing, and_pa virtually always clin this situation unless the operative pro AY junction modification 28,29) ostoperative AV block that is not expected to resolve, (Level of evidence: C) (30, 30a) aseular diseases with AV block such as muscular dystrophy, Kearns-Sayre syn- (Level of evidence: C) drome, Erb's dystrophy (limb-zidle, and pero uscular atrophy. (Level of evidence: B) (3 . Second-legree AV block regardless of type or site of block, with associated symptomatic bradycardia of evidence: B) (19) ‘Class Ha 1. Asymptomatic third-degree AV block at any anatomic site with average awake ventricular rates of 40 bpm or Faster. (Level of evidence: B, C) Asymptomatle type I second-degree AV block. (Level of evidence: B) (2123) Asymptomatic type T second-degree AV block at Intra- ‘or Infra levels found incidentally at electrophysto- logical study performed for other indications, Level of evidence: B) (192 | Flrst-degree AV block with symptoms suggestive of ppacomaker syndrome and documented alleviation of ns with temporary AV pacing. (Level of evidence B) (18,16) Marked firstalegree AV block (>030 second) In-pa- Ulents with LV dysfunetion and symptoms of congestive Iucart failure in whom a shorter AV interval results in hemodynamic improvement, presumably by decreasing Jett atrial filling pressure. (Level of evidence: ©) (17) u J. Asymptomatle first-degree AV block. (Level of evidence: 1B) (14) (See also “Pacing for Chronte Bifscleular and Teifascleular Block”) Asymptomatle type T second-degree AV Hock at the supra-His (AV node) level oF not known toe Intra- or Infra-Histan, (Level of evidence: B, C) (19) AV block expected to resolve and wnllkely to (eg, drug toxtity, Lyme disease). (Level of evidence: B) 1188 GREGORATOs ET AL_ PACEMAKER IMPLANTATION GUIDELINES Table 1. G uidelines for Choice of Pacemaker Generator in Selected Indications for Pacing JACC Vel 31,.No. 5 ‘Apri 1988:1175-208 Sinus Nede Dysfunction AV Block ‘Neurally Mediated Syncope of Carotid Sinas Hypersensivcy ‘Single chamber aural pacemaker « No suspected abnormaliy of AV conduction ‘and not at increased rik for fatore AV block fe Maintenance of AV synchrony daring pacing desired fe Rate response svalale if desied Single-chamber ventricular (© Maintenance of AV synchrony daring pacing pacemaker ot necessary (Rate response available if ested Dual-chamber pacemaker ‘© AV synchrony daring pacing desited Suspected abnormally of AV conduction or increased sk for fature AV block (Rate response available if desied gle tead,aalseasing [Not appropriate ventricle pacemaker s Not appropriate © Chronic atrial irlation or other aural tchvarthhia ot maintenance of AV synchrony turing pacing not aecesary (Rate response available if desired © AV synchrony during pacing esred Atri pacing desired Rate response available if desired Normal sinus node function and no noed fr atrial pacing Desire to limit he number of pacemaker lads Not appropriate (unless AV block stematically excluded) © Chronic atrial filation or other atrial tachyarrhythmia fe Rate response available i desired «Sinus mechanism present fe Rate response wallable it desired Not appropriate AV = atrioventricular