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©2013 UpToDate ® Print Email ACC/AHA/HRS guideline summary: Permanent pacing after the acute phase of myocardial infarction (MI) Class I - There is evidence and/or general agreement that permanent pacing after the acute phase of MI should be performed in the following settings: • 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 MI. (Level of Evidence: B) • Transient advanced second- or third-degree infranodal AV block and associated bundle branch block. If the site of block is uncertain, an eletrophysiological study may be necessary. (Level of Evidence: B) • Persistent and symptomatic second- or third-degree AV block. (Level of Evidence: C) Class IIb - The evidence or opinion is less well established that permanent pacing after the acute phase of MI is beneficial in the following setting: • Persistent second- or third-degree AV block at the AV node level, even in the absence of symptoms. (Level of Evidence: B) Class III - There is evidence that permanent pacing after the acute phase of MI is not useful and may be harmful in the following settings: • Transient AV block in the absence of intraventricular conduction defects. (Level of Evidence: B) • Transient AV block in the presence of isolated left anterior fascicular block. (Level of Evidence: B) • New bundle branch block or fascicular block in the absence of AV block. (Level of Evidence: B) • Persistent asymptomatic first-degree AV block in the presence of bundle branch or fascicular block. (Level of Evidence: B) Adapted from Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:e350.