When do you use pacemaker for myocardial infarction?







  • CLASS I (strong) of recommendation, LEVEL B-NR of evidence (moderate-quality evidence from 1 or more well-designed, well-executed nonrandomized studies, observational or registry studies; meta-analyses of such studies)

1. In patients presenting with an acute MI (myocardial infarction), temporary pacing is indicated for medically refractory symptomatic or hemodynamically significant bradycardia related to SND (sinus node dysfunction) or atrioventricular block.

 2. Patients who present with SND or atrioventricular block in the setting of an acute MI should undergo a waiting period before determining the need for permanent pacing. *

 3. In patients presenting with an acute MI with second-degree Mobitz type II atrioventricular block, high-grade atrioventricular block, alternating bundle-branch block, or third-degree atrioventricular block (persistent or infranodal), permanent pacing is indicated after a waiting period.
  • CLASS IIa (moderate), LEVEL B-NR

4. In patients with an acute MI with symptomatic or hemodynamically significant sinus bradycardia or atrioventricular block at the level of the atrioventricular node, the administration of atropine is reasonable.

  • CLASS III (harm), LEVEL B-NR

5. In patients with an acute MI and transient atrioventricular block that resolves, permanent pacing should not be performed.

 6. In patients with an acute MI and a new bundle-branch block or isolated fascicular block in the absence of second-degree or third-degree atrioventricular block, permanent pacing should not be performed.

 * the clinician should carefully consider and generally avoid early permanent pacing (  less than 72 hours), so as to potentially avoid unnecessary implantation of pacemakers.     
        Source: 2018 Bradycardia Clinical Practice Guidelines, 2018 ACC/AHA/HRS



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