Indications for pacemakers, implantable cardioverter-defibrillator and cardiac resynchronization devices

• Samii Soraya M.

Abstract

Key points

• Patients with symptomatic inappropriate bradycardia from either sinus node dysfunction or atrioventricular (AV) block should be evaluated for a pacemaker.
• Patients who are asymptomatic with AV block and have heart rates less than 40 beats per minute or asystolic pauses greater than 3 seconds in sinus rhythm or greater than 5 seconds in atrial fibrillation WHILE AWAKE should be evaluated for a pacemaker.
• Patients who have symptomatic sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) or have survived a cardiac arrest caused by VT/VF not from a reversible cause should be evaluated for implantable cardioverterdefibrillator (ICD).
• Patients who have chronic left ventricular (LV) systolic heart failure on guideline-directed medical therapy (GDMT) with an LV ejection fraction (EF) of 35% or less with New York Heart Association functional class II or III should be evaluated for ICD.
• Patients who have chronic LV systolic heart failure on GDMT with sinus rhythm and left bundle branch block and EF of 35% or less with QRS duration of 150 ms or greater should be evaluated for cardiac resynchronization therapy.

Med Clin N Am. 2015; Vol. 99: 795–804;

http://dx.doi.org/10.1016/j.mcna.2015.02.008

Keywords: arrhythmia, cardiac rhythm devices, pacemaker, implantable cardioverter-defibrillator, cardiac resynchroniza tion therapy, systolic heart failure