Indications for Pacemakers, Implantable Cardioverter-Defibrillators, and Cardiac Resynchronization Therapy: Identifying Patients Who Benefit from Cardiac Rhythm Devices

This chapter includes specific pediatric considerations within the broader categoriesAtrioventricular block that develops or worsens during exercise reflects conduction disease in the His–Purkinje system, which warrants implantation of a permanent pacemakerFor patients at high risk of ventricular tachycardia or ventricular fibrillation, but in whom comorbidities preclude immediate internal cardioverter-defibrillator implantation or for whom the risk is transient, a reasonable option is a wearable cardioverter defibrillatorProspective, randomized, clinical trials have demonstrated that cardiac resynchronization therapy improves left ventricular systolic function, heart failure symptoms, exercise tolerance, quality of life, and survivalBefore concluding that permanent pacing is indicated, the physician must carefully assess whether it is in the best interest of the patientThis assessment should include the specifics of the cardiac rhythm disturbance, the patient's general medical status, and the patient's concerns and preferences.