Homework 4: Indications for temporary pacemaker and permanent pacemaker

Temporary pacemaker
Class I
1. Asystole.
2. Symptomatic bradycardia (includes sinus bradycardia with hypotension and type I second-degree AV block with hypotension not responsive to atropine).
3. Bilateral BBB (alternating BBB, or RBBB with alternating LAFB/LPFB) (any age).
4. New or indeterminate age bifascicular block (RBBB with LAFB or LPFB, or LBBB).
5. Mobitz type II second-degree AV block.
Class IIa
1. RBBB and LAFB or LPFB (new or indeterminate).
2. RBBB with first-degree AV block.
3. LBBB, new or indeterminate.
4. Incessant VT, for atrial or ventricular overdrive pacing.
5. Recurrent sinus pauses (greater than 3 seconds) not responsive to atropine.
Class IIb
1. Bifascicular block of indeterminate age.
2. New or age-indeterminate isolated RBBB.
Class III
1. First-degree heart block.
2. Type I second-degree AV block with normal hemodynamics
3. Accelerated idioventricular rhythm.
4. Bundle branch block known to exist before acute MI.

Permanent pacemaker
1. Sinus node dysfunction - Class I, Class II, Drug-induced sinus node dysfunction
2. Acquired AV block - Class I, Class II, Drug-induced AV block
3. Post myocardial infarction - Class I, Class II
4. Neurocardiogenic syncope - Class I, Class II
5. Congenital complete heart block
6. Neuromuscular diseases
7. Special circumstances - Long QT syndrome, Hypertrophic cardiomyopathy, Heart failure, Cardiac transplantation, Bradycardia-induced ventricular arrhythmias