心脏起搏的适应症(英文版)课件

Dr.HOSSAMELMAHYCARDIOLOGYSPECIALTYREGISTRARROYALLANCASTERINFIRMARYH.ELMAHY2010Types of permanent pacing by indicationBrady pacing-different indicationsPacing after AMIContraindications of pacingCRTICDsH.ELMAHY 2010A:Bifascicular/trifascicular BlockB:AV blockC:Sinus node diseaseD:Neurally mediated syncopeE:Post AVN ablationH.ELMAHY 2010A:Symptoms such as syncope/presyncopeB:bradyarrhythmiaC:symptoms correlated to bradyarrhythmiaD:symptoms not correlated to arrhythmiaE:none of the aboveH.ELMAHY 2010A:persistent 2nd degree Type II AV blockB:transient 3rd degree block with LBBBC:Persistent 3rd degree block D:transient 2nd degree block with RBBBE:all of the aboveH.ELMAHY 2010A:Functional class NYHA III-VIB:normal SR+wide QRS(150 msec)or wide QRS(120-149 msec)with evidence of mechanical dyssynchrony on echoC:on optimum medical therapyD:all of the aboveE:none of the aboveH.ELMAHY 2010ACC/AHA/HRS 2008 PACING GUIDELINESNICE 2007 CRT GUIDELINESNICE 2006 ICD GUIDELINESH.ELMAHY 2010H.ELMAHY 2010H.ELMAHY 2010H.ELMAHY 2010H.ELMAHY 2010H.ELMAHY 2010H.ELMAHY 2010H.ELMAHY 2010When expected to resolve and/or unlikely to recur(e.g.Lyme disease or drug toxicity)Asymptomatic 1st degreeAsymptomatic type I 2nd degree H.ELMAHY 2010H.ELMAHY 2010H.ELMAHY 2010H.ELMAHY 2010 INDICATED NOT INDICATEDIntermittent 3rd degree blockAdvanced type II 2nd degree blockAlternating BBBFascicular block with out AV block or symptomsFascicular block with 1st degree AV block without symptoms H.ELMAHY 201063 y old male presented with acute inferior MI.he was thrombolysed.Thirty minutes later he developed VF arrest.CPR commenced and on ROSC he was in CHB with escape rate of 25 bpm.He was paced transcutaneously until a TPW was inserted.2 weeks later his 12 lead ECG showed SR with LAHB but no evidence of AVB.Should he get a PPM?H.ELMAHY 2010The need for TPW after AMI doesnt automatically indicate a need for PPMTransient conduction disturbances or LAHB are not indications for PPM after AMI.PPM is indicated in the presence of advanced AVB(2nd/3rd degree)whether(persistent)or(transient with associated BBB)H.ELMAHY 2010H.ELMAHY 2010Generally PPM is indicated when symptomatic bradycardia is presentAlso PPM indicated when symptomatic bradycardia is caused by long-term drug for which there is no accepted alternative.PPM is not indicated in the absence of symptoms.H.ELMAHY 2010PPM is indicated in Neurally mediated syncope when there isrecurrent syncope+hypersensitive cardio inhibitory responsePPM is not indicated if:1-hypersensitive cardio inhibitory response without symptoms OR2-Symptoms without hypersensitive cardio inhibitory responseH.ELMAHY 2010Issue date:May 2007Review date:July 2010NICE technology appraisal guidance 120Cardiac resynchronization therapy for the treatment of heart failureH.ELMAHY 2010H.ELMAHY 2010H.ELMAHY 2010Issue date:January 2006Review date:July 2007Technology Appraisal 95Implantable cardioverter defibrillators for arrhythmiasReview of Technology Appraisal 11H.ELMAHY 2010H.ELMAHY 2010H.ELMAHY 2010There are only two indications for pacing(excluding pacing for heart failure):1-symptoms+slow HR2-high risk of symptoms+slow HR developing in the futureH.ELMAHY 2010A:Bifascicular/trifascicular BlockB:AV blockC:Sinus node diseaseD:Neurally mediated syncopeE:Post AVN ablationH.ELMAHY 2010A:Symptoms such as syncope/presyncopeB:bradyarrhythmiaC:symptoms correlated to bradyarrhythmiaD:symptoms not correlated to arrhythmiaE:none of the aboveH.ELMAHY 2010A:persistent 2nd degree Type II AV blockB:transient 3rd degree block with LBBBC:Persistent 3rd degree block D:transient 2nd degree block with RBBBE:all of the aboveH.ELMAHY 2010A:Functional class NYHA III-VIB:normal SR+wide QRS(150 msec)or wide QRS(120-149 msec)with evidence of mechanical dyssynchrony on echoC:on optimum medical therapyD:all of the aboveE:none of the aboveH.ELMAHY 2010 THANK YOUH.ELMAHY 2010