Jordanian Task Force 2025 – Indications for Cardiac Device Implants
Jordanian Task Force 2025 – Indications for Cardiac Device Implants
Source: Dr. Basil Abu El Haija-Chair, Scientific Committee-Jordan EP Group (JCS)
Electrophysiology Task Force, October 2025
Event: Jordan Cardiac Society – 1st Electrophysiology Group Meeting
Keynotes:
1. Overview
• The Jordanian guidelines adopt international standards (ACC, AHA, HRS, ESC).
• Devices covered: Pacemaker (PPM), Implantable Cardioverter-Defibrillator (ICD), and Cardiac Resynchronization Therapy (CRT).
2. Permanent Pacemaker (PPM)
• Purpose: Prevent symptomatic bradycardia or AV conduction failure.
• Sinus Node Dysfunction (SND):
• Most common indication, especially in elderly (>65 years).
• ECG findings:
• Sinus bradycardia <40 bpm (with symptoms)
• Sinus pause ≥3 sec (≥5 sec in AF)
• Chronotropic incompetence (fails to reach 85% predicted HR)
• Symptoms: dizziness, fatigue, syncope, low exercise capacity.
• Atrioventricular (AV) Block:
• Complete (3rd-degree) or Mobitz II → always pace.
• Symptomatic Type I or marked 1st-degree → may benefit.
• Alternating bundle branch block → pacing due to high risk of progression.
• Post-MI AV Block:
• Inferior MI → observe 48–72 hrs (may recover).
• Anterior MI → implant early (rare recovery).
3. Implantable Cardioverter-Defibrillator (ICD)
• Goal: Prevent Sudden Cardiac Death (SCD) from VT/VF.
A. Secondary Prevention
• Survivors of cardiac arrest, sustained VT/VF, or arrhythmic syncope.
• Exclude reversible causes (ischemia, electrolytes, SVT).
• Post-MI VT/VF >48 hrs → revascularize; if persistent risk → ICD.
B. Primary Prevention
• Ischemic Cardiomyopathy:
• LVEF ≤35%, ≥40 days post-MI, not revascularizable.
• LVEF <40% + non-sustained VT + inducible VT/VF on EPS.
• Delay evaluation ≥90 days post-revascularization.
• Non-Ischemic Cardiomyopathy (NIDCM):
• LVEF ≤35% with NYHA II–III despite ≥3 months GDMT.
• Evidence: DEFINITE, SCD-HeFT trials.
• Inherited & Specific Diseases:
Long QT syndrome, Brugada syndrome, ARVC, and HCM.
Cardiac Sarcoidosis: if pacing is indicated, implant an ICD instead of a pacemaker because of the high risk of VT/VF and sudden death associated with diffuse myocardial involvement.
4. Cardiac Resynchronization Therapy (CRT)
• Goal: Improve LV synchrony and outcomes in systolic HF with electrical dyssynchrony.
• Device types: CRT-P (Pacemaker) or CRT-D (with Defibrillator).
Indications:
• Class I (Strong):
• LVEF ≤35%, QRS ≥150 ms, LBBB, NYHA II–IV.
• Class IIa (Intermediate):
• LVEF ≤35%, QRS 130–149 ms, LBBB.
• Non-LBBB (Consider):
• LVEF ≤35%, QRS ≥150 ms, NYHA III–IV.
Special Scenarios:
• Frequent ventricular pacing >40%, LVEF <50% → CRT (BLOCK-HF trial).
5. Clinical Summary
• PPM: for bradyarrhythmia (SND, AV block, post-MI block).
• ICD: for SCD prevention (ischemic, non-ischemic, or inherited).
• CRT: for heart failure with wide QRS or high pacing burden.
• Sarcoidosis: if pacing required, always implant ICD.
• Jordanian protocols align fully with ACC/AHA/HRS/ESC standards to ensure evidence-based and unified national practice.
