TOTAL AV BLOCK

Stroobandt et al, ECG from Basics to

Essentiall Step by Step. 2016
Stroobandt et al, ECG from Basics to
Essentiall Step by Step. 2016
Stroobandt et al, ECG from Basics to
Essentiall Step by Step. 2016
Stroobandt et al, ECG from Basics to
Essentiall Step by Step. 2016
Stroobandt et al, ECG from Basics to
Essentiall Step by Step. 2016
Stroobandt et al, ECG from Basics to
Essentiall Step by Step. 2016
Stroobandt et al, ECG from Basics to
Essentiall Step by Step. 2016
Stroobandt et al, ECG from Basics to
Essentiall Step by Step. 2016
 Total AV Block
Tidak ada konduksi melalui AV node
Terjadi disosiasi aktivitas atrial dan ventrikel
Mekanisme penyelamatan dapat terjadi dari
berkas di bawah AVN

Issa, et al. Clinical Arrhytmology and Electrophysiology : A Companion to Braunwalds Heart Disease. 2012
Issa, et al. Clinical Arrhytmology and Electrophysiology : A Companion to Braunwalds Heart Disease. 2012
 Total AV Block: Etiology
CONGENITAL ATRIOVENTRICULAR BLOCK
HEREDITARY PROGRESSIVE CARDIAC CONDUCTION DISEASE
ACQUIRED ATRIOVENTRICULAR BLOCK :
1. DRUGS
2. ACUTE MYOCARDIAL INFARCTION
3. CHRONIC ISCHEMIC HEART DISEASE
4. DEGENERATIVE DISEASES
5. RHEUMATIC DISEASES
6. INFILTRATIVE PROCESSES
7. NEUROMYOPATHIE
8. INFECTIOUS DISEASES
9. IATROGENIC
10. VAGALLY MEDIATED ATRIOVENTRICULAR BLOCK
11. LONG QT SYNDROME

Issa, et al. Clinical Arrhytmology and Electrophysiology : A Companion to Braunwalds Heart Disease. 2009;31
 CLINICAL PRESENTATION
Exercise intolerance
Easy fatigability
Dyspnea on exertion
Angina
Mental status changes
Dizziness
Near syncope to frank syncope
Issa, et al. Clinical Arrhytmology and Electrophysiology : A Companion to Braunwalds Heart Disease. 2012
 MANAGEMENT
PACING
IDENTIFY TRANSIENT OR REVERSIBLE CAUSES
(DRUGS, ELECTROLYTE, INFECTION, ISCHEMIA)

Issa, et al. Clinical Arrhytmology and Electrophysiology : A Companion to Braunwalds Heart Disease. 2012
Temporary Transvenous Pacemaker
Permanent Pacemaker
Issa, et al. Clinical Arrhytmology and Electrophysiology : A Companion to Braunwalds Heart Disease. 2012
 Initial Management

Issa, et al. Clinical Arrhytmology and Electrophysiology : A Companion to Braunwalds Heart Disease. 2012
 What is PPM ?
Electronic devices that stimulates the heart with
electrical impulses to maintain or restore a
normal heartbeat
Provides electrical stimuli to cause cardiac
contraction when intrinsic cardiac activity is
inappropriately slow or absent
Sense intrinsic cardiac electric potentials
Issa, et al. Clinical Arrhytmology and Electrophysiology : A Companion to Braunwalds Heart Disease. 2009;31
 Pacemaker System
Pulse Generator Pacing Lead

Right Atrium

Right Ventricle
 The Pulse Generator

Contains a battery to provide

energy for sending electrical
impulses to the heart Connector
Block
Houses the circuitry that
controls pacemaker Circuitry
operations
Includes a connector to join Battery
the pulse generator to the
lead(s)
General Transvenous Lead Design
The pacing lead conducts electricity
from the pacemaker to the heart.
 Leads
Insulated Wires
Deliver
electrical
impulses from Lead

the pulse
generator to
the heart
Sense cardiac
depolarization
 Two main types of Pacing System
Two main types of Pacing System:
Single Chamber Pacing or
Dual Chamber Pacing

Single Chamber Pacing Dual Chamber

Pacing
Atrial Pacing Ventricular Pacing

o
r
 Single Chamber Pacing
Atrial Advantages

Pacing Easy & Simple to implant

Ventricular chamber pacing was first
used in pacemaker implant
In general, cheaper, using older
technology
If patient have chronic atrial flutter or
fibrillation, ventricular chamber
pacing will be sufficient

Ventricular Pacing
Disadvantages
No AV synchrony in ventricular
chamber pacing => Decrease of
Cardiac Output
=> Pacemaker Syndrome
Atrial chamber pacing does not
provide ventricular backup if A-to-V
conduction is lost
 Dual Chamber Pacing

Dual Advantages
Chamber AV Synchrony =>
Pacing Increase of Cardiac Output
Improve Quality of Life

Disadvantages
Some physician think its
expEnsive
Technically harder & slightly
more complicated to implant
Complicated programming
TERIMAKASIH
Sistem Konduksi Listrik
Pemilihan moda pemacuan pada
DNS dan blok AV

PERHIMPUNAN ARITMIA INDONESIA dan PERHIMPUNAN DOKTER SPESIALIS KARDIOVASKULAR INDONESIA 2014