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Рекомендации ESC по кардиостимуляции и сердечной ресинхронизирующей терапии 2013
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Рекомендации Европейского Общества Кардиологов (ESC) по кардиостимуляции и сердечной ресинхронизирующей терапии 2013

2013 ESCGuidelines on cardiac pacing and cardiac resynchronization therapy
The Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA).








Authors/Task Force Members: Michele Brignole (Chairperson) (Italy)*,
Angelo Auricchio (Switzerland), Gonzalo Baron-Esquivias (Spain), Pierre Bordachar
(France), Giuseppe Boriani (Italy), Ole-A Breithardt (Germany), John Cleland (UK),
Jean-Claude Deharo (France), Victoria Delgado (Netherlands), Perry M. Elliott (UK),
Bulent Gorenek (Turkey), CarstenW. Israel (Germany), Christophe Leclercq
(France), Cecilia Linde (Sweden), Lluı´s Mont (Spain), Luigi Padeletti (Italy),
Richard Sutton (UK), Panos E. Vardas (Greece)

Table of Contents
Abbreviations and acronyms . . . . . . . . . . . . . . . . . . . . . . . . 2
Abbreviations: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Acronyms of the trials referenced in the recommendations or
reported in the tables: . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1. Preamble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2. Indications for pacing . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.1 Epidemiology, natural history, pathophysiology,
classification, and diagnosis of bradyarrhythmias considered for
permanent cardiac pacing therapy . . . . . . . . . . . . . . . . . . 5
2.2 Persistent bradycardia . . . . . . . . . . . . . . . . . . . . . . . 7
2.2.1 Indications for pacing . . . . . . . . . . . . . . . . . . . . . 7
2.2.2 Choice of pacing mode . . . . . . . . . . . . . . . . . . . . 9
2.3 Intermittent (documented) bradycardia . . . . . . . . . . . . 11
2.3.1 Indications for pacing . . . . . . . . . . . . . . . . . . . . . 11
2.3.2 Choice of pacing mode . . . . . . . . . . . . . . . . . . . . 13
Section 2.4 Suspected (undocumented) bradycardia . . . . . . 14
2.4.1 Bundle branch block . . . . . . . . . . . . . . . . . . . . . . 14
2.4.2 Reflex syncope . . . . . . . . . . . . . . . . . . . . . . . . . 16
2.4.3 Unexplained syncope (and fall) . . . . . . . . . . . . . . 18
3. Indications for cardiac resynchronization therapy . . . . . . . . . 19
3.1 Epidemiology, prognosis, and pathophysiology of heart
failure suitable for cardiac resynchronization therapy . . . . . . 19
Section 3.2 Patients in sinus rhythm . . . . . . . . . . . . . . . . . 20
3.2.1 Indications for cardiac resynchronization therapy . . . 20
3.2.1.1 Patients in New York Heart Association
functional class III–IV . . . . . . . . . . . . . . . . . . . . . . . 20
3.2.1.2 Patients in New York Heart Association
functional class I–II . . . . . . . . . . . . . . . . . . . . . . . . 20
3.2.1.3 Patient selection: role of imaging techniques to
evaluate mechanical dyssynchrony criteria to select
patients for cardiac resynchronization therapy . . . . . . . 23
3.2.2 Choice of pacing mode (and cardiac resynchronization
therapy optimization) . . . . . . . . . . . . . . . . . . . . . . . . 23
Section 3.3 Patients in atrial fibrillation . . . . . . . . . . . . . . . 26
3.3.1 Patients with heart failure, wide QRS, and reduced
ejection fraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
3.3.2 Patients with uncontrolled heart rate who are
candidates for atrioventricular junction ablation . . . . . . . . 27
3.4 Patients with heart failure and conventional pacemaker
indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
3.4.1 Patients with an indication for upgrading from
conventional pacemaker or implantable cardioverter
defibrillator to cardiac resynchronization therapy devices . 28
3.4.2 De novo cardiac resynchronization therapy pacing in
patients with conventional indication for anti-bradycardia
pacing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Section 3.5 Back-up implantable cardioverter defibrillator in
patients indicated for cardiac resynchronization therapy . . . . 31
3.5.1 Benefit of adding cardiac resynchronization therapy in
patients with indications for implantable cardioverter
defibrillator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.5.2 Benefit of adding implantable cardioverter defibrillator
in patients with indications for cardiac resynchronization
therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
4. Indications for pacing in specific conditions . . . . . . . . . . . . . 33
4.1 Pacing in acute myocardial infarction . . . . . . . . . . . . . . 33
4.2 Pacing after cardiac surgery, transcatheter aortic valve
implantation, and heart transplantation . . . . . . . . . . . . . . . 34
4.3 Pacing and cardiac resynchronization therapy in children
and in congenital heart disease . . . . . . . . . . . . . . . . . . . . 35
4.4 Pacing in hypertrophic cardiomyopathy . . . . . . . . . . . . 36
4.5 Pacing in rare diseases . . . . . . . . . . . . . . . . . . . . . . . 37
4.5.1 Long QT syndrome . . . . . . . . . . . . . . . . . . . . . . 38
4.5.2 Muscular dystrophies . . . . . . . . . . . . . . . . . . . . . 38
4.5.3 Mitochondrial cytopathies . . . . . . . . . . . . . . . . . . 38
4.5.4 Metabolic disorders . . . . . . . . . . . . . . . . . . . . . . 39
4.6 Pacing in pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . 39
4.7 Pacing for first-degree atrioventricular block
(haemodynamic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
4.8 Algorithms for prevention and termination of atrial
arrhythmias by pacing . . . . . . . . . . . . . . . . . . . . . . . . . . 39
5. Complications of pacing and CRT implantation . . . . . . . . . . . 41
6. Management considerations . . . . . . . . . . . . . . . . . . . . . . . 41
6.1 Pacing from alternative right ventricular sites . . . . . . . . . 41
6.2 Re-implantation of pacemaker/cardiac resynchronization
therapy after device explantation for infection . . . . . . . . . . 42
6.3 Magnetic resonance imaging in patients with implanted
cardiac devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
6.4 Emergency (transvenous) temporary pacing . . . . . . . . . 44
6.5 Remote management of arrhythmias and device . . . . . . 44
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
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