|Tests and Services
When is a permanent pacemaker Needed? - Guidelines
Class I - very definite evidence that the patient needs a pacemaker or ICD:
- Advanced second- or third-degree heart block, AV Block, associated with symptomatic bradycardia, slow heart rate, congestive heart failure, or low cardiac output.
- Sinus node dysfunction with heart rates slower than expected for age with associated symptoms (i.e., fatigue).
- Postoperative advanced second- or third-degree AV block that is not expected to resolve or persists at least 7 days after cardiac surgery.
- Congenital third-degree AV block with a wide QRS escape rhythm or ventricular dysfunction.
- 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.
- 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:
- Bradycardia-tachycardia syndrome with the need for long-term antiarrhythmic treatment other than digitalis.
- 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.
- Long QT syndrome with 2:1 AV or third-degree AV block.
- 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:
What is a permanent pacemaker?
When is a permanent pacemaker Needed? - Guidelines - Departments & Programs - Children's National Medical Center
- Temporary postoperative third-degree AV block that reverts to sinus rhythm with residual bifascicular block.
- Congenital third-degree AV block in the asymptomatic neonate, child, or adolescent with an acceptable rate, narrow QRS complex, and normal ventricular function.
- Asymptomatic sinus bradycardia in the adolescent with congenital heart disease with resting heart rate <35 bpm or pauses in ventricular rate >3 seconds.