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Pocket Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy

ESC Pocket Guidelines

Device Therapy
Cardiac Resynchronization Therapy (CRT)
Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Antibradycardia Pacing
Chronic Heart Failure
Implantable Cardioverter-Defibrillator (ICD)
Device Complications and Lead Extraction
Arrhythmias and Device Therapy

Publication Date: August 2021

Chairperson: Michael Glikson and Jens Cosedis Nielsen

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Table of Contents

  • Introduction
  • Background
  • Evaluation of the patient with suspected or documented bradycardia or conduction-system disease
    • History and physical examination
    • Electrocardiogram
    • Non-invasive evaluation
    • Implantable monitors
    • Electrophysiology study
  • Cardiac pacing for bradycardia and conduction system disease
    • Pacing for sinus node dysfunction
    • Pacing for atrioventricular block
    • Pacing for conduction disorders without atrioventricular block
    • Pacing for reflex syncope
    • Pacing for suspected (undocumented) bradycardia
  • Cardiac Resynchronization Therapy
    • Epidemiology, prognosis, and pathophysiology of heart failure suitable for cardiac resynchronization therapy by biventricular pacing
    • Indication for cardiac resynchronization therapy: patients in sinus rhythm
    • Patients in atrial fibrillation
    • Patients with conventional pacemaker or implantable cardioverter defibrillator who need upgrade to cardiac resynchronization therapy
    • Pacing in patients with reduced left ventricular ejection fraction and a conventional indication for antibradycardia pacing
    • Benefit of adding implantable cardioverter defibrillator in patients with indications for cardiac resynchronization therapy
  • Alternative site pacing
    • Septal pacing
    • His bundle pacing
    • Left bundle branch area pacing
    • Leadless pacing
  • Indications for pacing in specific conditions
    • Pacing in acute myocardial infarction
    • Pacing after cardiac surgery and heart transplantation
    • Pacing after transcatheter aortic valve implantation
    • Cardiac pacing and cardiac resynchronization therapy in congenital heart disease
    • Pacing in hypertrophic cardiomyopathy
    • Pacing in rare diseases
  • Special considerations on device implantations and perioperative management
  • Complications of cardiac pacing and cardiac resynchronization therapy
  • Management considerations
    • Magnetic resonance imaging in patients with implanted cardiac devices
    • Radiation therapy in pacemaker patients
    • Temporary pacing
    • Perioperative management in patients with cardiovascular implantable electronic devices
    • Cardiovascular implantable electronic devices and sports activity
    • When pacing is no longer indicated
    • Device follow-up
  • Patient-centered care and shared decision-making in cardiac pacing and cardiac resynchronization therapy