Harrisons 232 Permanent Pacemakers (in Bradyarrhythmia)

Question 1

Class I indicators for pacing in SA node dysfunction

Answer 1

1) Documented symptomatic bradycardia
2) Sinus node dysfunction associated with necessary long-term drug therapy
3) Symptomatic chronotropic incompetence

Question 2

What pacing mode is usually selected for patients with SA node dysfunction?

Answer 2

Dual-chamber. “Pacing modes that preserve AV synchrony appear to be associated with a reduction in the incidence of atrial fibrillation & improved quality of life.”

Question 3

What is the evidence for efficacy of pacing with AV block?

Answer 3

Trick question! AV block is a ticket straight to a pacemaker.

There are no randomized trials for this, because there aren’t any therapeutic alternatives and AV block is kinda deadly.

Question 4

In AV block, what’s the difference for considering pacemakers in symptomatic vs. asymptomatic patients?

Answer 4

#Symptomatic: "implantation should be performed in any patient with symptomatic bradycardia & irreversible 2nd or 3rd degree AV block"
#Asymptomatic: "Pacing in patients with asymptomatic AV block should be individualized"

Question 5

Do we like single- or dual-chamber pacing?

Answer 5

Dual! “In general, a pacing mode that maintains AV synchrony reduces complications of pacing such as pacemaker syndrome & pacemaker-mediated tachycardia.”