DIAGNOSIS PHYSIOLOGY/
FUNCTIONAL
CERTIFICATION RE-CERTIFICATION Bundle Branch Block
Axis Deviation
Progression of disease in the conduction system can lead to third degree heart block with total loss of electrical connection between the atria and ventricles causing syncope or sudden death. Yes if: Asymptomatic. (Depends on risk from underlying heart disease.) Yes, if treated for symptomatic disease (see pacemaker); no disqualifying heart disease; and cleared by cardiologist. No, if symptomatic. Every 2 years. Annual
101 RECOMMENDATION TABLES PACEMAKERS DIAGNOSIS PHYSIOLOGY/ FUNCTIONAL CERTIFICATION RE-CERTIFICATION Sinus node dysfunction Variable long term
prognosis depending on underlying disease, but cerebral hypoperfusion corrected by support of heart rate by pacemaker. No Yes if: 1 month after pacemaker implantation; and documented correct function by pacemaker center. Underlying disease is not disqualifying. Annual Documented pacemaker checks. Atrioventricular (AV) block
Variable long term prognosis depending on underlying disease, but cerebral hypoperfusion corrected by support of heart rate by pacemaker. No Yes if: 1 month after pacemaker implantation and documented correct function by pacemaker center, and underlying disease is not disqualifying. Annual Documented pacemaker checks.
102 RECOMMENDATION TABLES PACEMAKERS (Continued) DIAGNOSIS PHYSIOLOGY/ FUNCTIONAL CERTIFICATION RE-CERTIFICATION Neurocardiogenic syncope Excellent long-term survival prognosis but there is risk for syncope that may be due to cardioinhibitory (slowing heart rate) or vasodepressor (drop in blood pressure)
components, or both. Pacemaker will affect only cardioinhibitory component, but will lessen effect of vasodepressor component. No, with symptoms. Yes if: 3 months* after pacemaker implantation; and documented correct function by pacemaker center; Absence of symptom recurrence. Annual Documented pacemaker checks; Absence of symptom recurrence.
* Three months recommended due to possible vasodepressor component of syndrome not necessarily treated by pacing.
103 RECOMMENDATION TABLES PACEMAKERS (Continued) DIAGNOSIS PHYSIOLOGY/ FUNCTIONAL CERTIFICATION RE-CERTIFICATION Hypersensitive carotid
sinus with syncope
Excellent long-term survival prognosis but there is risk for syncope that may be due to cardioinhibitory (slowing heart rate) or vasodepressor (drop in blood pressure)
components, or both. Pacemaker will affect only cardioinhibitory component, but will lessen effect of vasodepressor component. No, with symptoms. Yes if: 3 months* after pacemaker implantation; and documented correct function by pacemaker center; Absence of symptom recurrence. Annual Documented regular pacemaker checks; and Absence of symptom recurrence.
*Three months recommended due to possible vasodepressor component of syndrome not necessarily treated by pacing.
104 RECOMMENDATION TABLES IMPLANTABLE DEFIBRILLATORS DIAGNOSIS PHYSIOLOGY/ FUNCTIONAL CERTIFICATION RE-CERTIFICATION Primary prevention Patient has high risk for
death and sudden incapacitation.
No
Secondary preve ntion Patient demonstrated to have high risk for death and sudden incapacitation.
105 References
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Congenital Heart Disease
Dr. Heidi Connolly The Mayo Clinic Rochester, Minnesota
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