2010年中华医学会心电生理和起搏分会心脏常规起搏治疗指南徐伟PPT.pptVIP

In recommendation 1e, “cardiac surgery” was added to specifically define the situation(s) in which this recommendation applies. Recommendation 1f has been expanded to indicate that pacing therapy is recommended in patients with neuromuscular diseases and AV block whether or not they are symptomatic, in view of the unpredictable progression of AV conduction in this group of diseases. Type I second-degree AV block is usually due to delay in the AV node, irrespective of QRS width . Progression to advanced AV block is uncommon. Type II second-degree AV block is usually infranodal (either intra- or infra-His) especially when the QRS is wide. Symptoms are frequent and progression to advanced AV block is common. When type II second-degree AV block occurs with a wide QRS, pacing becomes a Class I recommendation. The “narrow QRS” addition in #2 will now enable physicians to indicate patients for pacing that present with type-II second-degree AV block on evaluation (Holter or ECG)—whether or not they are symptomatic. A long PR interval may identify a group of patients with LV dysfunction some of whom may benefit from dual chamber pacing with a shorter AV delay. Some small, nonrandomized trials have suggested that there may be some symptomatic and functional improvement by pacing patients with shorter AV intervals. Pacing therapy is recommended in patients with neuromuscular diseases and AV block whether or not they are symptomatic, in view of the unpredictable progression of AV conduction in this group of diseases. Bifascicular block is when 2 of the conduction system pathways below the AV node are blocked. They are defined as one of the following: Right bundle branch block and left anterior hemiblock - marked by prolonged QRS (120 ms or .12 seconds or longer) Right bundle branch block and left posterior hemiblock Complete left bundle branch block (both left anterior and left posterior) Bifascicular block refers to ECG evidence of impaired conduction below