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Indications for pacing
In
Special conditions
Dr. Ahmed Taha Hussein
M.Sc.Cardiology
Electrophysiology specialist
Assistant...
Updates of the guidelines
Specific conditions
▪ Acute myocardial infarction
▪ Pacing after cardiac surgery,transcatheter aortic
valve implantation,a...
Acute myocardial infarction
▪ Incidence 3.2% after PCI and thrombolytics.
▪ AWMI associated high degree AV block is
always...
Acute myocardial infarction
Post-cardiac surgery
▪ AV-block occurs in 1-4% cases :
▪ In 8% after repeated surgery , 20 - 40% in
calcific aortic valve ...
TAVI
▪ AV-block post TAVI reaches 14% , especially
with CoreValve prosthesis .
▪ Independant predictors : use of the CoreV...
Heart transplantation
▪ SN-dysfunction is common up to 8% fo cases.
▪ Causes :surgical trauma, sinus node artery
damage, o...
Children
May be early manifestations
is sudden cardiac death,
Adam stokes attackes or
heart failure.
Pacing site RV vs LV
...
Children
SN-dysfunction
CRT
The evidence is
limited to case
reports.
Single site LV
pacing (apex/mid
lateral wall)
Hypertrophic cardiomyopathy
▪ uncommon in (HCM), but in context,
can suggest specific aetiologies (for
example, PRKAG2 gene...
Rare diseases
LQT- syndromes
ICD (with active pacing) is preferable in patients with
symptoms unresponsive
to ß-blocker th...
Pregnancy
▪ Vaginal delivery carries no extra risks in a
mother with congenital complete heart block.
▪ For women who have...
1st degree AV-block
Prolonged PR interval lead ineffective atrial systole,
and diastolic MR , increased PCWP and pulmonary...
ATP-atrial algorithm
Rate-adaptive pacing, which periodically assesses the underlying
intrinsic rate to pace just above it...
Thank you
Pacing in special conditions 2013 guidelines
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Pacing in special conditions 2013 guidelines

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this is the new guidelines 2013 for pacing in special conditions like AMI , congenital heart diseases , hereditary diseases and HOCM , pregnancy and algorithm for ATP

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Pacing in special conditions 2013 guidelines

  1. 1. Indications for pacing In Special conditions Dr. Ahmed Taha Hussein M.Sc.Cardiology Electrophysiology specialist Assistant lecturer Zagazig university
  2. 2. Updates of the guidelines
  3. 3. Specific conditions ▪ Acute myocardial infarction ▪ Pacing after cardiac surgery,transcatheter aortic valve implantation,and heart transplantation. ▪ Pacing and cardiac resynchronization therapy in children and in congenital heart disease. ▪ Pacing in hypertrophic cardiomyopathy. ▪ Pacing in rare diseases. ▪ Pacing in pregnancy. ▪ Pacing for first-degree atrioventricular block (haemodynamic).
  4. 4. Acute myocardial infarction ▪ Incidence 3.2% after PCI and thrombolytics. ▪ AWMI associated high degree AV block is always below Hiss bundle , while IWMI usually above Hiss bundle . ▪ Usually resolve spontaneously within 2-7 days. ▪ 9% need Permenant pacing later on. ▪ Newely developed Intraventricular condcution defect usually associated with high mortality due extensive myonecrosis ... CRT criteria.
  5. 5. Acute myocardial infarction
  6. 6. Post-cardiac surgery ▪ AV-block occurs in 1-4% cases : ▪ In 8% after repeated surgery , 20 - 40% in calcific aortic valve and TV-replacement. ▪ SN-dysfunction may occur in CABG, lateral atriotomy , trans-septal superior approaches to the MV. ▪ In clincial practice 5-7 days observation period applied before PPM.
  7. 7. TAVI ▪ AV-block post TAVI reaches 14% , especially with CoreValve prosthesis . ▪ Independant predictors : use of the CoreValve prosthesis and evidence of conduction system dysfunction, either pre- existing RBBB or AV lock at the time of TAVI. ▪ New-onset persistent LBBB is common following TAVI, but its significance is unclear. ▪ Even TAVI patients meet the criteria for CRT , experience is very limited.
  8. 8. Heart transplantation ▪ SN-dysfunction is common up to 8% fo cases. ▪ Causes :surgical trauma, sinus node artery damage, or ischaemia and prolonged cardiac ischaemic times. ▪ Av-block is less common and is probably related to inadequate preservation. ▪ Chronotropic incompetence is always present following standard orthotopic heart transplantation. ▪ Observation period several weeks , in clinical consensus 3 weeks .
  9. 9. Children May be early manifestations is sudden cardiac death, Adam stokes attackes or heart failure. Pacing site RV vs LV Epicardial vs endocardial
  10. 10. Children SN-dysfunction CRT The evidence is limited to case reports. Single site LV pacing (apex/mid lateral wall)
  11. 11. Hypertrophic cardiomyopathy ▪ uncommon in (HCM), but in context, can suggest specific aetiologies (for example, PRKAG2 gene mutations, Anderson-Fabry disease and amyloidosis). ▪ CRT may be considered in individual cases in which there is some evidence for systolic ventricular impairment. RV apical pacing
  12. 12. Rare diseases LQT- syndromes ICD (with active pacing) is preferable in patients with symptoms unresponsive to ß-blocker therapy or pause-dependent ventricular arrhythmia according to current ICD guidelines. Muscular dystrophies Emery-Dreifuss MD once bradycardia appeared , but thromboebolism are not preventable by pacing. athy and mitochondrial diseases , pacing with ICD back-up is the recommended Other types of desmopapproach.
  13. 13. Pregnancy ▪ Vaginal delivery carries no extra risks in a mother with congenital complete heart block. ▪ For women who have a stable, narrow, complex junctional escape rhythm, PM implantation can be deferred until after delivery.
  14. 14. 1st degree AV-block Prolonged PR interval lead ineffective atrial systole, and diastolic MR , increased PCWP and pulmonary congestion. DDD -- LV dysfunction Functional Atrial undersensing --shift of P wave
  15. 15. ATP-atrial algorithm Rate-adaptive pacing, which periodically assesses the underlying intrinsic rate to pace just above it, elevation of the pacing rate after spontaneous atrial ectopy, transient high-rate pacing after mode switch episodes and increased post-exercise pacing to prevent an abrupt drop in heart rate.
  16. 16. Thank you

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