Does pacing in the setting of AV block and myocardial infarction require the presence of symptoms?

No. Symptoms related to the form of block are not a requirement. The indications in large part are treated to the intraventricular conduction defects that result from infarction. The prognosis of patients requiring pacing is influenced more by the extent of the infarction than by symptoms. Pacing in the setting of an acute myocardial infarction may be temporary rather than long-term or permanent.

What are the indications for pacing after myocardial infarction?

Indications in this setting do not require the presence of symptoms. Pacing is indicated in the setting of acute myocardial infarction for (1) complete third-degree block or advanced second-degree block that is associated with block in the His-Purkinje system (wide complex ventricular rhythm) and (2) transient advanced (second- or third-degree) AV block with a new bundle-branch block.

What is the anatomic location of bifascicular or trifascicular block?

Bifascicular or trifascicular block is located below the AV node and involves a combination of either two or three of the fascicles of the right or left bundle (divided into the left anterior and left posterior fascicle).

Are symptoms required for permanent pacing in the setting of bifascicular and trifascicular block?

Yes. Symptoms must be present in the setting of bifascicular and trifascicular block, just as in acquired AV block.

What are the indications for permanent pacing in bifascicular and trifascicular block?

Pacing is indicated when bifascicular or trifascicular block is associated with (1) complete block and symptomatic bradycardia or (2) intermittent type II second-degree block with or without related symptoms.

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