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When is a permanent pacemaker Needed? - Guidelines


Class I - very definite evidence that the patient needs a pacemaker or ICD:
  1. Advanced second- or third-degree heart block, AV Block, associated with symptomatic bradycardia, slow heart rate, congestive heart failure, or low cardiac output.
  2. Sinus node dysfunction with heart rates slower than expected for age with associated symptoms (i.e., fatigue).
  3. Postoperative advanced second- or third-degree AV block that is not expected to resolve or persists at least 7 days after cardiac surgery.
  4. Congenital third-degree AV block with a wide QRS escape rhythm or ventricular dysfunction.
  5. Congenital third-degree AV block in the infant with a ventricular rate <50 to 55 bpm or with congenital heart disease and a ventricular rate <70 bpm.
  6. Sustained pause-dependent ventricular tachycardia (VT), with or without prolonged QT, in which the efficacy of pacing is thoroughly documented.

Class IIa - most doctors agree that having a pacemaker or ICD would be beneficial:

  1. Bradycardia-tachycardia syndrome with the need for long-term antiarrhythmic treatment other than digitalis.
  2. Congenital third-degree AV block beyond the first year of life with an average heart rate <50 bpm or with long pauses between heart beats.
  3. Long QT syndrome with 2:1 AV or third-degree AV block.
  4. Asymptomatic sinus bradycardia in the child with complex congenital heart disease with resting heart rate >35 bpm or pauses in ventricular rate >3 seconds.

Class IIb - most doctors agree that a pacemaker or ICD would not be beneficial:

  1. Temporary postoperative third-degree AV block that reverts to sinus rhythm with residual bifascicular block.
  2. Congenital third-degree AV block in the asymptomatic neonate, child, or adolescent with an acceptable rate, narrow QRS complex, and normal ventricular function.
  3. Asymptomatic sinus bradycardia in the adolescent with congenital heart disease with resting heart rate <35 bpm or pauses in ventricular rate >3 seconds.
What is a permanent pacemaker?
When is a permanent pacemaker Needed? - Guidelines - Departments & Programs - Children's National Medical Center