Gregoratos G. et al. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2002. Available at www.acc.org/clinical/guidelines/pacemaker/pacemaker.pdfACC/AHA/NASPE ACC/AHA/NASPE 心脏起搏器植入指南心脏起搏器植入指南Gregoratos G. et al. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2002. Available at www.acc.org/clinical/guidelines/pacemaker/pacemaker.pdfACC/AHA ACC/AHA 适应证分类适应证分类 I类: 根据病情状况，有明确证据或专家们一致认 为起搏治疗对患者有益、有用或有效。 II类: 根据病情状况，起搏治疗给患者带来的益处 和效果证据不足或专家们的意见有分歧。IIa类: 证据/意见偏向有用/有效。IIb类: 证据/意见不能说明有用/有效。Gregoratos G. et al. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2002. Available at www.acc.org/clinical/guidelines/pacemaker/pacemaker.pdfACC/AHA ACC/AHA 适应证分类适应证分类 III类: 根据病情状况，专家们一致认为起 搏治疗无效，甚至某些情况下对患者 有害，因此不需要/或不应该植入心脏 起搏器。Gregoratos G. et al. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2002. Available at www.acc.org/clinical/guidelines/pacemaker/pacemaker.pdfLevel A从含有大数量病例的多次随机临床试验 得出的数据.Level B从含有较小量病人的有限次试验得出的 数据或从设计较 好的非随机研究中分析 得出的数据或登记的观察数据.Level C专家的意见是建议的主要来源.ACC/AHA ACC/AHA 临床证据分类临床证据分类Gregoratos G. et al. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2002. Available at www.acc.org/clinical/guidelines/pacemaker/pacemaker.pdfSection I-A:成人获得性完全性房室阻滞的起搏治疗Gregoratos G. et al. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2002. Available at www.acc.org/clinical/guidelines/pacemaker/pacemaker.pdfI I 类适应证类适应证: :获得性房室阻滞的起搏治疗获得性房室阻滞的起搏治疗 任何阻滞部位的三度和高度房室阻滞: 有房室阻滞所致的症状性心动过缓(包括心力衰 竭) 需要药物治疗其他心律失常或其他疾病，而所 用药物治疗可导致症状性心动过缓 无症状，但已证实心室停搏 3.0s或清醒状态时 逸搏心律 40 bpm, 尤其是合并心肌病和左心室功 能不良 无症状的二度 II型房室阻滞，伴窄QRS波Gregoratos G. et al. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2002. Available at www.acc.org/clinical/guidelines/pacemaker/pacemaker.pdfIIaIIa 类适应证类适应证: :获得性房室阻滞的起搏治疗获得性房室阻滞的起搏治疗 无症状性二度 I 型房室阻滞，电生理检查发现 阻滞部位在希氏束内或以下水平 一度或二度房室阻滞伴有类似起搏器综合征的 临床表现Gregoratos G. et al. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2002. Available at www.acc.org/clinical/guidelines/pacemaker/pacemaker.pdfIIbIIb 类适应证类适应证: :获得性房室阻滞的起搏治疗获得性房室阻滞的起搏治疗 合并有左心室功能不全或充血性心力衰竭症状的 显著一度房室阻滞(0.30 sec.)，缩短AV间期可能 降低左心房充盈压而改善心力衰竭症状者 神经肌源性疾病伴发的任何程度的房室阻滞，无 论是否有症状Gregoratos G. et al. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2002. Available at www.acc.org/clinical/guidelines/pacemaker/pacemaker.pdfIII III 类适应证类适应证: :获得性房室阻滞的起搏治疗获得性房室阻滞的起搏治疗 无症状的一度房室阻滞 无症状发生于希氏束以上的二度 I 型房室阻滞 预期可以恢复且不再复发的房室阻滞(如药物中毒 ，莱姆疾病等)，或无缺氧症状的睡眠呼吸暂停综 合征Gregoratos G. et al. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2002. Available at www.acc.org/clinical/guidelines/pacemaker/pacemaker.pdfSection I-B:慢性双分支和三分支阻滞的起搏治疗Gregoratos G. et al. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2002. Available at www.acc.org/clinical/guidelines/pacemaker/pacemaker.pdfI I 类适应证类适应证: :慢性双分支和三分支阻滞的起搏治疗慢性双分支和三分支阻滞的起搏治疗 间歇性三度房室阻滞 二度 II 型房室阻滞 交替性双侧支阻滞Gregoratos G. et al. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2002. Available at www.acc.org/clinical/guidelines/pacemaker/pacemaker.pdfIIaIIa 类适应证类适应证: :慢性双分支和三分支阻滞的起搏治疗慢性双分支和三分支阻滞的起搏治疗 虽未证实晕厥由房室阻滞引起，但可排除由于其 它原因引起的晕厥，尤其是室性心动过速 无临床症状，但电生理检查发现 HV 间期