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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy

ESC Clinical Practice Guidelines

Pacing is an important part of electrophysiology and of cardiology in general. Whereas some of the situations requiring pacing are clear and have not changed over the years, many others have evolved and have been the subject of extensive recent research, such as pacing after syncope, pacing following transcatheter aortic valve implantation, cardiac resynchronisation therapy (CRT) for heart failure (HF) and for prevention of pacing-induced cardiomyopathy, and pacing in various infiltrative and inflammatory diseases of the heart, as well as in different cardiomyopathies.

Other novel topics include new diagnostic tools for decision-making on pacing, as well as a whole new area of pacing the His bundle and the left bundle branch. In addition, attention has increased in other areas, such as how to systematically minimise procedural risk and avoid complications of cardiac pacing, how to manage patients with pacemakers in special situations, such as when magnetic resonance imaging (MRI) or irradiation are needed, how to follow patients with a pacemaker with emphasis on the use of remote monitoring, and how to include shared decision-making in caring for this patient population.

Cardiac Resynchronization Therapy (CRT)
Chronic Heart Failure
Arrhythmias and Device Therapy

Main resources

Full text and related materials

Full text

Corrigendum (Published on 16 February 2022)


Declarations of interest


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Scientific Presentation at ESC Congress 2021

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ESC TV Interview

The essentials of the Guidelines in less than four minutes.

Congress News Article

Insights from the Chairs of the Guidelines Task Force.

Slide set

Educational material.

ESC Cardio Talk

With Michael Glikson from Israel and Jens Cosedis Nielsen from Denmark.