Pacing Indications

Question 1

Chronotropic incompetence

Answer 1

Class 1

Question 2

Symptomatic sinus bradycardia with symptoms but not documented

Answer 2

Class 2a

Question 3

Syncope of unexplained origin but Sinus abnormalities discovered after EP study

Answer 3

Class 2a

Question 4

Symptomatic sinus bradycardia as a result of a necessary drug

Answer 4

Class 1

Question 5

indication that is not necessarily an outright contraindication to pacing, but it suggests that the risk is equal to the benefit

Answer 5

Class 2b

Question 6

minimally symptomatic patients with chronic heart rates less than 40 bpm

Answer 6

Class 2b

Question 7

sinus node dysfunction (even if it can be documented) if the patient is asymptomatic

Answer 7

Class III

Question 8

patient with sinus node dysfunction and symptoms of brady- cardia, if there is documented evidence that those symptoms occur in the absence of bradycardia

Answer 8

Class III

Question 9

patient takes non essential drug therapy and, as a result, develops documented sinus bradycardia with symptoms

Answer 9

Class III

Question 10

Third-degree or advanced second-degree AV block at any anatomic level with symptomatic bradycardia

Answer 10

Class I

Question 11

third-degree or advanced second-degree AV block at any anatomic level associated with arrhythmias and other medical conditions that require drug therapy that results in symptomatic bradycardia

Answer 11

Class 1 (The drug therapy must be required and essential.)

Question 12

third-degree or advanced second-degree AV block plus at least one of the following: pauses(3 secs or more), bradycardia, or an escape rate originating below the AV node (less than 40bpm)

Answer 12

Class I

Question 13

third-degree or advanced second-degree AV block is AV block at any anatomic level following catheter ablation of the AV junction

Answer 13

Class I

Question 14

third-degree or advanced second-degree AV block at any anatomic level that is associated with post- operative AV block and is not expected to resolve after cardiac surgery

Answer 14

Class I

Question 15

third-degree or advanced second-degree AV block at any anatomic level associated with
neuromuscular diseases such as Kearns–Sayre syndrome, Erb dystrophy, and peroneal muscular atrophy.

Answer 15

ClassI

Question 16

Second-degree AV block associated with symp- tomatic bradycardia, regardless of the type of site of the block.

Answer 16

Class I

Question 17

Asymptomatic persistent third-degree AV block at any anatomic site with an average awake ventric- ular rate of 40 bpm or higher if one or more of the following are present: cardiomegaly or left ventric- ular dysfunction or the block site is below the AV node. In this case, the patient has third-degree AV block but no symptoms and must have cardiomeg- aly (enlarged heart), some type of pump compro- mise (left ventricular dysfunction), or an AV block site below the AV node. AV block sites below the AV node are more common in advanced AV block.

Answer 17

Class I

Question 18

Second-degree or third-degree AV block during exercise in the absence of myocardial infarction. In acute myocardial infarction, symptomatic brady- cardia can be transient, that is, it may go away on its own. For such patients, temporary pacing may be a preferable option.

Answer 18

Class I

Question 19

Asymptomatic second-degree type II AV block with a wide QRS

Answer 19

Class I

Question 20

Asymptomatic second-degree type II AV block with a narrow QRS

Answer 20

Class IIa

Question 21

SSS with documented symptomatic bradycardia

Answer 21

Class 1