par Pitisci, Lorenzo 
;Bentea, Georgiana ;Verdiner, Ricardo R.E.;Casado Arroyo, Ruben
Référence Textbook of Critical Care, Elsevier, page (598.e1-604.e1)
Publication Publié, 2023-01
;Bentea, Georgiana ;Verdiner, Ricardo R.E.;Casado Arroyo, Ruben Référence Textbook of Critical Care, Elsevier, page (598.e1-604.e1)
Publication Publié, 2023-01
Partie d'ouvrage collectif
| Résumé : | Bradyarrhythmias are common in the intensive care unit and are mainly represented by sinus node dysfunction and atrioventricular node blockade (AV block). Locating the AV blockage site helps predict prognosis and response to medical treatment. Reversible causes must be ruled out, especially myocardial ischemia. AV blocks are categorized as supra-Hisian and intra- or infra-Hisian. Supra-Hisian have a thin QRS, have a good prognosis, and usually are responsive to chronotropic drugs. Intra- or infra-Hisian have a wide QRS, have a bad prognosis, and usually are unresponsive or worsened by chronotropic drugs. Medical therapy is essentially supportive and prescribed for a short period. Temporary pacing is indicated for acute treatment of severe symptomatic bradycardia as a bridge to permanent pacing or recovery. It can be delivered transcutaneously or transvenously. Permanent pacing can be delivered with a subcutaneous pulse generator connected through leads to one or multiple chambers (atrium, ventricle) or through a leadless intracardiac pacemaker. Pacing mode and pacing rate are set according to the level of the block, sinus rhythm, and lead integrity. Complications related to pacing system malfunction are failure to sense, oversensing, loss of capture, and electromagnetic interference. |
