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Conduction disturbances and pacemaker 

Conduction disturbances and pacemaker
Conduction disturbances and pacemaker

Carlo Lavalle

, Renato Pietro Ricci

, and Massimo Santini


February 22, 2018: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

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date: 09 July 2020

The most frequent clinical conditions complicated by bradyarrhythmias or atrioventricular blocks seen in an emergency setting are the degeneration of the conduction system, acute myocardial infarction, drug toxicity, and hyperkalaemia. Pacemaker malfunction is another cause of potentially life-threatening bradyarrhythmias. The presence of signs/symptoms of hypoperfusion and the localization of the block condition the therapeutic approach. Treatment of bradyarrhythmias and atrioventricular block in a critical care setting may be preventative or therapeutic. A preventative approach is necessary when the risk of a sudden block with an inadequate ventricular escape rhythm is present, but the patient is asymptomatic. Symptomatic patients require immediate treatment. If the block is located at His bundle level or at bundle branch level, atropine may be ineffective and may even worsen the degree of the block. If drug administration is ineffective, transvenous temporary pacing is indicated. Transcutaneous cardiac pacing is another temporary method of pacing indicated in various critical clinical settings.

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