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©2013 UpToDate ® Print Email ACC/AHA/HRS guideline summary: Indications for pacing to prevent tachycardia Class I - There is evidence and/or general agreement that pacing should be used to prevent tachycardia in the following setting: • Sustained pause-dependent ventricular tachycardia (VT), with or without QT prolongation. (Level of Evidence: C) Class IIa - The weight of evidence or opinion is in favor of the usefulness of pacing to prevent tachycardia in the following setting: • High-risk patients with congenital long QT syndrome. (Level of Evidence: C) Class IIb - The weight of evidence or opinion is less well established for the usefulness of pacing to prevent tachycardia in the following setting: • Prevention of symptomatic, drug-refractory, recurrent atrial fibrillation in patients with coexisting sinus node dysfunction. (Level of Evidence: B) Class III - There is evidence and/or general agreement that pacing to prevent tachycardia is not useful in the following settings: • Frequent or complex ventricular ectopic activity without sustained VT in the absence of the long QT syndrome. (Level of Evidence: C) • Torsade de pointes VT due to reversible causes. (Level of Evidence: A) 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.