AHA 2018/ESC 2021 Pacing/CRT Flashcards
When to arrange exercise testing for bradyarrhyhtmia?
When associated bradycardia/symptoms with or post exercise
What infection should be tested for in Brady?
Lyme titres
When to test for genetic testing for brady?
when prsents with < 50y
What frequency of symptoms (or less) to recommend ILR for brady?
Monthly or less
2 class 1 indications in SND?
-Symptomatic Sinus Node Disease
-Symptomatic Sinus bradycardia from GDMT
Two class 2a:
-Tachy-brady syndrome
-Symptomatic chronotropic incompetence
Recommendations for pacing in AV block?
-AF with symptomatic slow ventricular response
-Heart block, Mobitz II or high grade AV block despite symptoms
-2nd degree heart block of CHB or HV > 70 in neuromuscular disease
-Symptomatic AV block due to GDMT
2 class 1 indications for pacing in BBB?
-Unexplained syncope with bifascicular block and HV > 70
-Alternating BBB
What is the class 1 indication for reflex syncope?
- > aged 40 with recurred syncope who had asystolic syncope with tilt table testing, cardioinhibitory CSS or spontaneous documented symptomatic asystolic paus > 3s or asymptomatic pauses > 6s
When can leadless pacemakers be considered? (3)
-No upper extremity venous access
-Risk of device pocket infection is high (previous infection)
-IHD
Pacing post MI Indications? How long to wait?
CHB, Mobitz II, High grade AVB, Alternating bundle branch block
Wait 5 days
How long to wait after CHB for PPM post CABG?
5 days
What valve prosthetic to avoid RV lead?
-Mechanical TVR
3 ECG predictors of PPM post AVR?
-RBBB
-LAFB
-Prolonged PR interval
3 patient related RFs for PPM after AVR?
-Older
-Male
-BMI
3 procedural related RFs for PPM in AVR?
-Valve in valve
-Self expandable valve
-Larger ratio between prosthesis diameter vs annulus of LVOT
2 class 1 indications for PPM after TAVR?
-Alternating BBB
-Persistent high grade AVB
What to implant PPM in NMD?
-Any second or third degree ABV
-HV > 70
What condition where any AVB, BBB or fascicular disease should warrant PPM?
Kearns-Sayre
What is antibiotic regimen before CIED?
-Within 1 hours of skin incision
What is definition of Sinus brady according to AHA 2018?
< 50 bpm
5 Infectious causes of bradycardia?
Myocarditis
Lyme disease
Chagas
Toxoplasmosis
Diphtheria
Infective Endocarditis
3 inflammatory causes of brady?
Scleroderma
RA
SLE
Should you get an echo for LBBB?
Yes (Class 1 indication)
Three electrolyte abnormalities that cause brady?
Hyperkalemia
Hypokalemia
Hypoglycemia
What are three congenital causes of heart block?
-Maternal SLE
-SCN5A mutation
-L-TGA
4 infectious causes of heart block?
-Toxo
-Lyme
-Endocarditis with abscess
-Chagas
3 muscular dystrophies that can cause heart block?
“KEMP”
Kearns-Sayre
Erb’s dystrophy
Myotonic dystrophy
Pascicohumeral delay
When to implant PPM in Kearns Sayre/Myotonic Dystrophy? When to implant ICD?
-CHB, 2nd degree regardless of symptoms, HV > 70 regardless of symptoms
-ICD if survival > 1 year expected
What are 2 class 1 indications for PPM in conduction system disease with 1:1 conduction?
-Alternating bundle branch blocks
-Syncope with BBB AND HV > 70 msec on EPS
What is recommended in patients post Afib surgery?
Temporary Epicardial pacing wires
5 indications for pacing in congenital heart block?
-Symptomatic bradycardia
-Wide QRS escape rhythm
-Mean HR < 50
-Complex ventricular ectopy
-Ventriculaar dysfunction
Pacing indications in acute MI?
-TVP: Medically refractory symptomatic or hemodynamically significant bradycardia related to SND or AV block
-Permanent: Mobitz II, High grade AV block, CHB, Alternated Bundle branch block after a waiting period
