By Brahadeesh Chandrasekaran, Healthcare Research Analyst, EIA
Pacemakers and Implantable Cardioverter Defibrillators (ICD) has been around for more than 2 decades for the treatment of cardiac arrhythmias. Every year approximately 100, 000 people withstand cardiac arrest in Germany. Bradycardia, a condition caused when the ventricular rate falls below 50/min accounts for approximately 20% of the people who suffer from cardiac arrest. Tachycardia is the common arrhythmia accounting for approximately 80% of the people withstanding cardiac arrest in Germany.
Pacemaker Therapy - When it is used?
Pacemakers are used when the patients develop major clinical indications due to insufficient ventricular rates. The indications include dizziness, syncope, heart failure and myocardial ischemia. Artificial pacing can be temporary or permanent.
Table 1 explains the conditions for temporary pacing and permanent pacing.
Source: Hans-Joachim Trappe and Jan Gummert, Current Pacemaker and Defibrillator therapy, Wellens et. al., The ECG in emergency decision making.
AV block is cause by myocardial ischemia, heightened vagal tone and necrosis and usually it is treated with permanent pacemaker. Temporary pacing therapy is provided only during the pre-hospital phase when Bradycardia remains symptomatic. AV block is a serious condition especially in patients with anterior wall infarction. The patients are immediately provided with temporary pacemakers.
In case of Sinus Node dysfunction, temporary pacing therapy is used provided that the patient shows significant improvement that cannot be achieved by medical treatment. If there is no significant improvement in the patient, then permanent pacing is recommended. Sinus node dysfunction appears in approximately 12% of the patients suffering from myocardial infarction. It is estimated that approximately 25% of the myocardial infarction patients suffer from AV block.Patients who develop left bundle branch block and unstable hemodynamics should undergo temporary pacing therapy. It occurs in patients with anterior wall infarction.