ACC/AHA Guidelines for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices: Executive Summary

Context Syncope is a commonly encountered by primary care physicians and cardiologists. Etiology is frequently not apparent, and patients may undergo unnecessary tests. Treatment must be tailored to the likely etiology. Complexities of diagnosis and treatment often warrant referral to a specialist. Objective To highlight the evolving recommendations for managing syncope in a clinically and cost effective manner. Evidence Acquisition An electronic literature search was undertaken of the Medline database from January 1996 to April 2006, using the Medical Subject Heading syncope, defibrillators, pacemakers, echocardiogram, cardiomyopathy, long QT syndrome, Arrhythmogenic right ventricular dysplasia, and Brugada syndrome. Abstracts and titles were reviewed to identify English-language trials. Bibliographies from the references as well as scientific statements from the Heart Rhythm Society, American Heart Association, and American College of Cardiology were reviewed. Evidence Synthesis A methodical approach to syncope can improve diagnosis, limit testing, and identify patients at risk of fatal outcome. A thorough history, physical exam and electrocardiogram are critical to the initial diagnosis. Presence of heart disease determines the extent of work-up and treatment. A trans-thoracic echocardiogram should be performed in patients with an unclear diagnosis and a positive cardiac history or an abnormal ECG. Ventricular arrhythmias are the most common cause of syncope in patients with structural heart disease. Patients with an ejection fraction less than 30 percent should receive an implantable defibrillator with few exceptions. An electrophysiology study may assist risk stratification in syncopal patients with borderline ventricular function. In patients without structural heart disease, the presence of a well defined arrhythmia syndrome consistent with a genetically determined risk of sudden death must be sought. The 12-lead electrocardiogram, family history and clinical presentation will identify most high-risk patients. Patients without structural heart disease can often be managed conservatively with well defined strategies for preventing neurocardiogenic syncope. Conclusions Managing syncope requires a methodical approach. An understanding of the limitations of the diagnostic tools and treatments is important. Lethal causes of syncope make it imperative to recognize the appropriate timing of referring patients to specialists.

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“…However, pacing is not warranted in the absence of a hyperactive cardioinhibitory response, or if avoidance behavior is effective. 39 …”

Section: Workup For Syncopementioning

confidence: 99%

Evaluation and Management of Syncope

Bindra

Marchlinski

Lin

2008

Clinical medicine. Circulatory, respiratory and pulmonary medic

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“…The guidelines of AHA/ACC are essentially the same as those in Japan (34,35). As to hemodynamically stable VT with remote myocardial infarction, there is a controversy in the risk evaluation but patients with spontaneous sustained VT are usually indicated for ICD (36,37).…”

Section: Secondary Prevention Of Scdmentioning

confidence: 99%

Indications for an Implantable Cardioverter Defibrillator (ICD)

2004

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Since the first clinical use of implantable defibrillator in human, the technology and the function of implantable cardioverter-defibrillator (ICD) have been much improved and now, ICD can be implanted within the chest wall. ICD is the most reliable therapy to prevent sudden cardiac death (SCD) in patients with documented VT/VF and the efficacy is most clear in patients with depressed heart function. It is now extended as a tool of the primary prevention of SCD in high risk patients after myocardial infarction. However, such beneficial effect is not applicable to DCM though patients might have depressed heart function. ICD is not free from procedure-or devicerelated problems which need to be resolved.

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“…The national and international guidelines, however, published from a consensus of medical societies, suggest an initial implantation of a dual-chamber pacemaker in patients with atrioventricular blocks, as these are theoretically more physiological than ventricular pacemakers [2,3].…”

Section: Introductionmentioning

confidence: 99%

Efeitos da mudança de modo de estimulação ventricular para atrioventricular sobre a qualidade de vida em pacientes com cardiopatia chagásica e bloqueio atrioventricular na troca eletiva do gerador de pulsos

Teno¹,

Costa²,

Filho³

et al. 2005

Rev Bras Cir Cardiovasc

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Health-related quality of life in patients with Chagas' cardiomiopathy and complete atrioventricular block at elective pulse generator replacement: effects of pacing mode upgraded from VVI to DDD 24 TENO, LAC ET AL -Health-related quality of life in patients with Chagas' cardiomiopathy and complete atrioventricular block at elective pulse generator replacement: effects of pacing mode upgraded from VVI to DDD J Cardiovasc Surg 2005; 20(1): 23-32 Braz

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ACC/AHA Guidelines for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices: Executive Summary

Cited by 294 publications

References 0 publications

Evaluation and Management of Syncope

Evaluation and Management of Syncope

Indications for an Implantable Cardioverter Defibrillator (ICD)

Efeitos da mudança de modo de estimulação ventricular para atrioventricular sobre a qualidade de vida em pacientes com cardiopatia chagásica e bloqueio atrioventricular na troca eletiva do gerador de pulsos

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