-Vị trí gắn của dây điện cực..
Khuyến cáo Tạo nhịp chậm?
GS. Huỳnh văn MInh, ĐHYD Huế, 2017
Khuyến cáo mới trong tạo nhịp / nhịp chậm
Recommendations Class Level
Cardiac pacing for bradycardia and conduction system disease
Pacing is indicated in symptomatic patients with the bradycardia-tachycardia form of SND to correct bradyarrhythmias and enable pharmacological
treatment, unless ablation of the tachyarrhythmia is preferred. I B Pacing is indicated in patients with atrial arrhythmia (mainly AF) and permanent
or paroxysmal third- or high-degree AVB irrespective of symptoms. I C In patients with SND and DDD PM, minimization of unnecessary ventricular
pacing through programming is recommended. I A
AF = atrial fibrillation; AVB = atrioventricular block; DDD = dual-chamber, atrioventricular pacing; PM = pacemaker; SND = sinus node dysfunction.
www.escardio.org/guidelines 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy (European Heart Journal 2021 –doi:10.1093/eurheartj/ehab364)
©ESC
Recommendations Class Level
Cardiac pacing for bradycardia and conduction system disease (continued) Dual chamber cardiac pacing is indicated to reduce recurrent syncope in patients aged >40 years with severe, unpredictable, recurrent syncope who have:
• spontaneous documented symptomatic asystolic pause/s >3 s or asymptomatic pause/s >6 s due to sinus arrest or AVB; or
• cardioinhibitory carotid sinus syndrome; or
• asystolic syncope during tilt testing.
I A
In patients with recurrent unexplained falls, the same assessment as for
unexplained syncope should be considered. IIa C
New recommendations in 2021 (9)
AVB = atrioventricular block
Khuyến cáo mới trong tạo nhịp / nhịp chậm & bệnh lý dẫn truyền
GS. Huỳnh văn MInh, ĐHYD Huế, 2017
©ESC
Recommendations Class Level
Cardiac pacing for bradycardia and conduction system disease (continued) AF ablation should be considered as a strategy to avoid pacemaker
implantation in patients with AF-related bradycardia or symptomatic pre- automaticity pauses, after AF conversion, taking into account the clinical situation.
IIa C
In patients with the bradycardia-tachycardia variant of SND, programming of
atrial ATP may be considered. IIb B
Dual-chamber cardiac pacing may be considered to reduce syncope recurrences in patients with the clinical features of adenosine-sensitive syncope.
IIb B
New recommendations in 2021 (10)
AF = atrial fibrillation; ATP = antitachycardia pacing; SND = sinus node dysfunction.
Khuyến cáo mới trong tạo nhịp / nhịp chậm & bệnh lý dẫn truyền
www.escardio.org/guidelines 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy (European Heart Journal 2021 –doi:10.1093/eurheartj/ehab364)
©ESC
Recommendations Class Level
In patients with SND and a DDD pacemaker, minimization of unnecessary
ventricular pacing through programming is recommended. I A Pacing is indicated in SND when symptoms can clearly be attributed to
bradyarrhythmias. I B
Pacing is indicated in symptomatic patients with the bradycardia-tachycardia form of SND in order to correct bradyarrhythmias and enable pharmacological treatment, unless ablation of the tachyarrhythmia is preferred.
I B
Recommendations for pacing in sinus node dysfunction (1)
ATP = antitachycardia pacing; DDD = dual-chamber, atrioventricular pacing; SND = sinus node dysfunction.
Khuyến cáo tạo nhịp ở bệnh nhân RLCNNX
GS. Huỳnh văn MInh, ĐHYD Huế, 2017
www.escardio.org/guidelines 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy (European Heart Journal 2021 –doi:10.1093/eurheartj/ehab364)
©ESC
Recommendations Class Level
In patients with syncope, cardiac pacing may be considered to reduce recurrent syncope when asymptomatic pause(s) >6 s due to sinus arrest is documented.
IIb C
Pacing may be considered in SND when symptoms are likely to be due to
bradyarrhythmias, when the evidence is not conclusive. IIb C Pacing is not recommended in patients with bradyarrhythmias related to SND
that are asymptomatic or due to transient causes that can be corrected and prevented.
III C
Recommendations for pacing in sinus node dysfunction (3)
ATP = antitachycardia pacing; DDD = dual-chamber, atrioventricular pacing; SND = sinus node dysfunction.
Khuyến cáo tạo nhịp ở bệnh nhân RLCNNX
www.escardio.org/guidelines 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy (European Heart Journal 2021 –doi:10.1093/eurheartj/ehab364)
©ESC
Recommendations Class Level
Pacing is indicated in patients in SR with permanent or paroxysmal third- or second-degree type 2, infranodal 2:1 or high-degree AVB, irrespective of symptoms.a
I C
Pacing is indicated in patients with atrial arrhythmia (mainly AF) and
permanent or paroxysmal third- or high-degree AVB irrespective of symptoms. I C In patients with permanent AF in need of a pacemaker, ventricular pacing with
rate-response function is recommended. I C
Pacing should be considered in patients with second-degree type 1 AV block that causes symptoms or is found to be located at intra- or infra-His levels at EPS.
IIa C
Recommendations for pacing for atrioventricular block (1)
AF = atrial fibrillation; AV = atrioventricular; AVB = atrioventricular block; DDD = dual-chamber, atrioventricular pacing; EPS = electrophysiology study; SR = sinus rhythm.
aIn asymptomatic narrow QRS-complex and 2:1 AVB, pacing may be avoided if supra-Hisian block is clinically suspected (concomitant Wenckebach is observed and block disappears with exercise) or demonstrated at EPS.
Khuyến cáo tạo nhịp ở bệnh nhân Bloc nhĩ thất
GS. Huỳnh văn MInh, ĐHYD Huế, 2017
Fred M. Kusumoto. Circulation. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society, Volume: 140, Issue: 8, Pages: e382-e482, DOI:
(10.1161/CIR.0000000000000628)
GS. Huỳnh văn MInh, ĐHYD Huế, 2017
Fred M. Kusumoto. Circulation. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society, Volume: 140, Issue: 8, Pages: e382-e482, DOI:
(10.1161/CIR.0000000000000628)
GS. Huỳnh văn MInh, ĐHYD Huế, 2017
Figure 1. Evaluation of Bradycardia and Conduction Disease Algorithm
Patient with symptoms suggestive of or consistent with bradycardia or
conduction disorder Comprehensive history and physical examination
(Class I)
SND Diagnostic algorithm
Nondiagnostic
Ambulatory ECG monitoring
(Class I) Conduction disorder with
1:1 AV conduction AV Block
SND*
AV Block Diagnostic algorithm
Conduction disorder Diagnostic algorithm§
No Exercise ECG testing
(Class IIa) Yes
Normal Abnormal
ECG (Class I)
Significant arrythmias
No significant arrhythmias
AV Block Diagnostic algorithm
Observation SND
SND Diagnostic algorithm
Conduction disorder with 1:1 AV conduction
Conduction disorder Diagnostic algorithm§ AV Block
Exercise-related symptoms Sleep apnea?
Directed blood testing (Class IIa)
Echocardiography if structural heart disease suspected
Continued concern for bradycardia?
Infrequent Symptoms (>30 days)
ICM (Class IIa)
GS. Huỳnh văn MInh, ĐHYD Huế, 2017
Figure 2. Initial Evaluation of Suspected or Documented SND Algorithm
Evidence for sinus node dysfunction*
Yes No
Treat underlying cause as needed, (e.g., sleep apnea
(Class I)
Transthoracic echocardiography
(Class IIa) Yes
No Reversible or physiologic cause
Treatment effective or unnecessary
Observe
Yes
Suspicion for infitrative CM,
endocarditis, ACHD Yes Advanced imaging
(Class IIa)
No
Symptoms
Yes No Observe
Electrophysiology study (if performed for other reasons) Suspicion for
structural heart disease
Treat identified abnormalities
No
Exercise related
Yes No
If not already performed:
Exercise ECG testing (Class IIa)
Diagnostic
Yes No
If not already performed:
Ambulatory ECG monitoring (Class I)
Can we make these lines even?
Can we fix this arrow?