Блокада левой ножки пучка Гисса

можно ли доверять дисперсионному картированию на кардиовизоре

Class I

1. -Blocker therapy should be used in all patients with left ventricular systolic dysfunction (ejection fraction
40%) with heart failure or prior myocardial infarction, unless contraindicated. (Use should be limited to
carvedilol, metoprolol succinate, or bisoprolol, which have been shown to reduce mortality.) (
138,140,141)

(Level of Evidence: A)
AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2011 Update -

J. Am. Coll. Cardiol. published online Nov 3, 2011

Recommendations for Acquired Atrioventricular Block
in Adults

CLASS I
1.
Permanent pacemaker implantation is indicated for third-degree
and advanced second-degree AV block at any anatomic level
associated with bradycardia with symptoms (including heart
failure) or ventricular arrhythmias presumed to be due to AV
block.
(Level of Evidence: C) (59,63,76,85)

2.
Permanent pacemaker implantation is indicated for third-degree
and 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.
(Level of Evidence: C)
(59,63,76,85)

3.
Permanent pacemaker implantation is indicated for third-degree
and advanced second-degree AV block at any anatomic level in
awake, symptom-free patients in sinus rhythm, with documented
periods of asystole greater than or equal to 3.0 seconds
(86) or any escape rate less than 40 bpm, or with an escape rhythm that
is below the AV node.
(Level of Evidence: C) (53,5

4.
Permanent pacemaker implantation is indicated for third-degree
and advanced second-degree AV block at any anatomic level in
awake, symptom-free patients with AF and bradycardia with 1 or
more pauses of at least 5 seconds or longer.
(Level of Evidence: C)

5.
Permanent pacemaker implantation is indicated for third-degree
and advanced second-degree AV block at any anatomic level after
catheter ablation of the AV junction.
(Level of Evidence: C) (87,8

6.
Permanent pacemaker implantation is indicated for third-degree
and advanced second-degree AV block at any anatomic level
associated with postoperative AV block that is not expected to
resolve after cardiac surgery.
(Level of Evidence: C) (84,85,89,90)

7.
Permanent pacemaker implantation is indicated for third-degree
and advanced second-degree AV block at any anatomic level
associated with neuromuscular diseases with AV block, such as
myotonic muscular dystrophy, Kearns-Sayre syndrome, Erb dystrophy
(limb-girdle muscular dystrophy), and peroneal muscular atrophy,
with or without symptoms.
(Level of Evidence: B) (91–97)

8.
Permanent pacemaker implantation is indicated for seconddegree
AV block with associated symptomatic bradycardia regardless
of type or site of block.
(Level of Evidence: B) (74)

9.
Permanent pacemaker implantation is indicated for asymptomatic
persistent third-degree AV block at any anatomic site with
average awake ventricular rates of 40 bpm or faster if cardiomegaly
or LV dysfunction is present or if the site of block is below
the AV node.
(Level of Evidence: B) (76,7

10.
Permanent pacemaker implantation is indicated for second- or
third-degree AV block during exercise in the absence of myocardial
ischemia.
(Level of Evidence: C) (81,82)


CLASS IIa

1.
Permanent pacemaker implantation is reasonable for persistent
third-degree AV block with an escape rate greater than 40 bpm
in asymptomatic adult patients without cardiomegaly.
(Level of
Evidence: C)
(59,63,64,76,82,85)

2.
Permanent pacemaker implantation is reasonable for asymptomatic
second-degree AV block at intra- or infra-His levels found at
electrophysiological study.
(Level of Evidence: B) (74,76,7

3.
Permanent pacemaker implantation is reasonable for first- or
second-degree AV block with symptoms similar to those of
pacemaker syndrome or hemodynamic compromise.
(Level of
Evidence: B)
(70,71)

4.
Permanent pacemaker implantation is reasonable for asymptomatic
type II second-degree AV block with a narrow QRS. When
type II second-degree AV block occurs with a wide QRS, including
isolated right bundle-branch block, pacing becomes a Class I
recommendation. (See Section 2.1.3, “Chronic Bifascicular
Block.”)
(Level of Evidence: B) (70,76,80,85)


CLASS IIb

1.
Permanent pacemaker implantation may be considered for neuromuscular
diseases such as myotonic muscular dystrophy, Erb
dystrophy (limb-girdle muscular dystrophy), and peroneal muscular
atrophy with any degree of AV block (including first-degree AV
block), with or without symptoms, because there may be unpredictable
progression of AV conduction disease.
(Level of Evidence:
B)
(91–97)

2.
Permanent pacemaker implantation may be considered for AV
block in the setting of drug use and/or drug toxicity when the
block is expected to recur even after the drug is withdrawn.
(Level of Evidence: B)
(98,99)


CLASS III

1.
Permanent pacemaker implantation is not indicated for asymptomatic
first-degree AV block.
(Level of Evidence: B) (69) (See
Section 2.1.3, “Chronic Bifascicular Block.”)

2.
Permanent pacemaker implantation is not indicated for asymptomatic
type I second-degree AV block at the supra-His (AV
node) level or that which is not known to be intra- or infra-Hisian.
(Level of Evidence: C)
(74)

3.
Permanent pacemaker implantation is not indicated for AV block
that is expected to resolve and is unlikely to recur
(100) (e.g., drug toxicity, Lyme disease, or transient increases in vagal tone
or during hypoxia in sleep apnea syndrome in the absence of
symptoms).
(Level of Evidence: B) (99,100)