Durasi pemasangan temporary pacemaker

Temporary Pace Maker DurationWidi Nugraha HadianTemporary transvenous pacing shall not be used routinely.Temporary transvenous pacing should be limited to case :High degree AV block without escape rhytmLife threatening bradyarrhytmias, such as in :a. Acute Myocardial Infarctionb During Interventional Procedures (ex; PCI)c. Drug Toxicityd. Concomitant systemic infection

Sumber : ESC Cardiac Pacing and Cardiac Resynchronization Therapy 2013If the indications for permanent pacing are established, every effort should be made to implant a permanent Pacemaker as soon as possible.Sumber : ESC Cardiac Pacing and Cardiac Resynchronization Therapy 2013Pacing in Acute Myocardial InfarctionAV block complicating acute myocardial infarction most often resolves itself spontaneously within 2-7 days. with only 9% patients requiring permanent pacing.

Permanent cardiac pacing does not influence the prognosis of these patients and therefore is not recommended.Sumber : ESC Cardiac Pacing and Cardiac Resynchronization Therapy 2013

Results : Patients with fibrinolytic therapy :Median Duration of the AV block was 45 minutes (range : 5 minutes - 48 hours)Patients without fibrinolytic therapy :Median duration of the AV block was 24 hours (range : 15 minutes 9 days)

Conclusion :Duration of the block seems to be shorter in patients treated with fibrinolytic therapy. Indication For Permanent Pacing in MI

Sumber : ESC Cardiac Pacing and Cardiac Resynchronization Therapy 2013

Indication For Permanent Pacing in MISumber : ESC Cardiac Pacing and Cardiac Resynchronization Therapy 2013Indication For Permanent Pacing in MI

Sumber :ESC Cardiac Pacing and Cardiac Resynchronization Therapy 2013Indication For Permanent Pacing in MIClass IPersistent second-degree AV block in the His Purkinje system with bundle branch block or third-degree AV block within or below the HisPurkinje system after acute MI. (Level of evidence: B.)Transient advanced (second- or third-degree) infranodal AV block and associated bundle branch block. (Level of evidence: B.)Persistent and symptomatic second or third-degree AV block.(Level of evidence: C.)

Sumber : ACC/AHA/HRS 2008 Guidelines for Device Based Therapy of Cardiac Rhytm AbnormalityClass IIb

Permanent ventricular pacing may be considered for persistent second or third degree AV block at the AV node level, even in the absence of symptoms. (Level of Evidence: B) (58)

Sumber : ACC/AHA/HRS 2008 Guidelines for Device Based Therapy of Cardiac Rhytm Abnormality

Commonly used medication that may cause sinus node dysfunction or Atrioventricular BlockDigitalis Antihypertensive Agents (clonidine,methyldopa, guanethidine)Beta Adrenegic Blocker (inderal, metoprolol, nadolol, ateprolol)Calcium Channel Blockers (Verapamil, Diltiazem)Type 1 A antyarrhytmia drugs (Quinidine, procainamide)Type 1 C antiarrhytmic drugs (flecainide, Propafenone)Type III antyarrhytmic drugs (amiodarone, sotalol)Psychotropic MedicationSumber : Indications for permanent and temporary cardiac pacing Robert W Peters, Pugazhendhi Vijayaraman, Kenneth A Ellenbogen

Pacing during Cardiac CatheterizationCardiac catheterization may induce transient RBBB blocks lasts for seconds or minutes, but can occasionally last for hours or days.Sumber : Indications for permanent and temporary cardiac pacing Robert W Peters, Pugazhendhi Vijayaraman, Kenneth A Ellenbogen

Low rate of infection during the first week of transvenous temporary pacing. Longer duration of temporary pacing complication rate increase.

Routine use of prophylactic antibiotics is not necessary unless: There is a sign of infection Pacing is prolonged (>7 days) Femoral access is used

TERIMA KASIHCondition Indicated For Permanent PacingSinus Node DysfunctionAcquired Atrioventricular Block in AdultsChronic Bifasicular BlockAtrioventricular Block Associated With Acute Myocardial InfarctionHypersensitive Carotid Sinus Syndrome and Neurocardiogenic SyndromeSumber : ACC/AHA/HRS 2008 Guidelines for Device Based Therapy of Cardiac Rhytm Abnormality

Sumber : Management of Cardiac Arrhytmias - Yan GH