Ventricular asystole of 3 seconds or more on Holter monitoring is frequently symptomatic and is proposed by the authors as a definite indication for permanent pacemaker implantation.
May inform symptomatic pause evaluation on monitoring; Level 5 data leaves open prospective validation of pacing indications.
A total of 2350 consecutive Holter recordings revealed that 53 patients had ventricular asystole of 3 seconds or more. The diagnoses based on the longest pauses were: sinus arrest in 19; AV block in 5; slow atrial fibrillation in 29. Symptoms occurred in 45 and were absent in 8 patients. Associated heart disease was present in only 33 cases. A pacemaker was implanted in 7 out of 8 asymptomatic patients. Ventricular asystole of 3 seconds or more is proposed as a definite indication for the implantation of a permanent pacemaker.
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Ector et al. (1983) studied this question.
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