Israeli Paramedics Association

Class I (*)

Systolic blood pressure < 80 mmHg , change in mental status ,
Angina , Pulmonary Edema

Class IIa

Unresponsive to pharmacology therapy

Class IIb

Supraventricular or Ventricular (currently indicate only in special situations
referectory to pharmacologic therapy or electrical cardioversion

Class IIb

Pacing not routinely recommended in such patients. If used at all ,
pacing should be used as early as possible after onset of arrest.

Class I

* Symptomatic sinus node disfunction
* 2nd degree AVB type II (**)
* 3rd degree AVB (Complete AVB)
* Newly ecquired left , right or alternating bundle branch block or bifascicular block

(*) Hemodynamically Compormising Bradycardia
        Including CAVB (3rd degree AVB) , symptomatic 2nd degree AVB , symptomatic
        sick sinus syndrom , drug-induced bradycardias (ie, Digoxin , Beta Blockers , Calcium
        channal blockers , Procainamide) , permanent pacemaker failure , Idioventricular
        bradycardias , symptomatic atrial Fibrillation with slow ventricular responce , refractory
        bradycardia during rescucitation of Hypovolemic shock and bradyarrhythmias with
        malignant ventricular escape mechanism.

(**) In patients with an inferior Myocadial Infarction , relatively - asymptomatic 2nd or 3rd
        degree AVB  can occure.  Pacing in such patients shoul be used on symptoms or
        deteriorating bradycardia. 

AHA , ACLS , 1994 ; 5-2

Paramedic Neomi Zvi - Jan 2000