Implantable cardiac devices

2018 Pacemakers for conduction delay

SA node

· SA node scars with age

· PPM for SA node dysfunction only if symptomatic

· Nocturnal bradycardias are usually due to OSA -> Sleep study

AV node

· Second degree AV block Mobitz 2 -> PPM always

· High grade AV block -> PPM always

· Other AVs block -> PPM only if symptoms

· Concomitant heart failure -> Bi-V PPM

· Concomitant severe heart failure -> Bi-V PPM + AICD (?)

Bundle branches

· RBBB often benign

· LBBB often due to structural heart disease -> TTE

Heart failure

· LVEF <40: drugs

· LVEF <35 (non-ischaemic) and NYHA 2-3: AICD

· LVEF + frequenct monomorphic ectopics: catheter ablation

Ischaemia

· AMI + sustained VT + failed anti-arrhythmics: ? ablation ? AICD

Other

· Subcut AICD preferable if not needing pacing

· Young healthy patients with suspected dangerous arrhythmias need genetic testing, and so do their relatives

· Don’t insert ICD if short life expectancy