Recommendations for Permanent Pacing After the Acute Phase of Myocardial Infarction

Class I 

(1) Permanent ventricular pacing is indicated for persistent second- degree AV block in the His-Purkinje system with alternating bundle-branch block or third-degree AV block within or below the His-Purkinje system after ST-segment elevation myocardial infarction.

(2) Permanent ventricular pacing is indicated for transient advanced second- or third-degree infranodal AV block and associated bundle-branch block. If the site of block is uncertain, an electrophysiological study may be necessary.

(3) Permanent ventricular pacing is indicated for persistent and symptomatic second- or third-degree AV block.

Class IIb

(1) Permanent ventricular pacing may be considered for persistent second- or third-degree AV block at the AV node level, even in the absence of symptoms.

Class III

(1) Permanent ventricular pacing is not indicated for transient AV  block in the absence of intraventricular conduction defects.

(2) Permanent ventricular pacing is not indicated for transient AV block in the presence of isolated left anterior fascicular block.

(3) Permanent ventricular pacing is not indicated for new bundle-branch block or fascicular block in the absence of AV block.

(4) Permanent ventricular pacing is not indicated for persistent asymptomatic first-degree AV block in the presence of bundle-branch or fascicular block.

JACC. 2008; 51; 2085-2105.