Table 4: Syllabus for the CIED specialist

4.1. History and physical examination

4.2. ECG

4.3. Non-invasive investigation (ambulatory ECG monitoring, exercise testing, head up tilt testing, imaging, laboratory and genetic tests) 

4.4. Invasive evaluation: electrophysiological testing 

4.5. Guidelines and indications for pacing

• Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022;24:71–164.
• Leonelli FM, De Ponti R, Bagliani G. Challenges in Bradicardias Interpretation. Card Electrophysiol Clin. 2019 Jun;11(2):261-281.
• Reed MJ. Approach to syncope in the emergency department. Emerg Med J. 2019 Feb;36(2):108-116.
• El-Hussein MT, Cuncannon A. Syncope in the Emergency Department: A Guide for Clinicians. J Emerg Nurs. 2021 Mar;47(2):342-351.
• Sakhi R, Theuns DAMJ, Szili-Torok T, Yap SC. Insertable cardiac monitors: current indications and devices. Expert Rev Med Devices. 2019 Jan;16(1):45-55.
• Varma N, Cygankiewicz I, Turakhia M, et al. 2021 ISHNE/HRS/EHRA/APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society. J Arrhythm. 2021;37(2):271-319.
• Quartieri F, Harish M, Calò L, et al. New insertable cardiac monitors show high diagnostic yield and good safety profile in real-world clinical practice: results from the international prospective observational SMART Registry. 2023;25(5):euad068

5. Heart Failure and indications for CRT

5.1. Pathophysiology of heart failure

5.2. Indications for CRT in heart failure 

5.3. Mechanism of action of CRT, role of bundle-branck block and QRS duration

• Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022;24:71–164.
• McDonagh TA, Metra M, Adamo M, et al.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-3726.
• McDonagh TA, Metra M, Adamo M, et al.; ESC Scientific Document Group. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023;44(37):3627-3639.
• Harjola VP, Mullens W, Banaszewski M, et al. Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management. A review on behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur J Heart Fail 2017;19:821–836

6. Evaluation of patients for ICD therapy

6.1. History and physical examination

6.2. ECG and ambulatory monitoring

6.3. Non-invasive evaluation: imaging (echo, cardiac magnetic resonance, and advanced imaging techniques) 

6.4. Invasive evaluation: electrophysiological testing

• Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al. ESC Scientific Document Group. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eu Heart J. 2022; 43(40): 3997-4126.
• McDonagh TA, Metra M, Adamo M, et al.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-3726.
• McDonagh TA, Metra M, Adamo M, et al.; ESC Scientific Document Group. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023;44(37):3627-3639.
• Harjola VP, Mullens W, Banaszewski M, et al. Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management. A review on behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur J Heart Fail 2017;19:821–836.
• Mahida S, Sacher F, Dubois R, et al. Cardiac imaging in patients with ventricular tachycardia. Circulation 2017;136:2491–2507.
• Fernández-Armenta J, Berruezo A, Andreu D, et al. Three-dimensional architecture of scar and conducting channels based on high resolution ce-CMR: insights for ventricular tachycardia ablation. Circ Arrhythm Electrophysiol 2013;6:528–537.

7. evaluation of patients considered for CRT 

7.1. History and examination

7.2. ECG and imaging

7.3. Special considerations; CRT and defibrillator therapy, device upgrade

• Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022;24:71–164.
• McDonagh TA, Metra M, Adamo M, et al.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-3726.
• Cleland JGFF, Daubert J-C, Erdmann E, et al. The Effect of Cardiac Resynchronization on Morbidity and Mortality in Heart Failure. N Engl J Med 2005;352:1539–49.
• Bristow MR, Saxon LA, Boehmer J, et al. Cardiac-Resynchronization Therapy with or without an Implantable Defibrillator in Advanced Chronic Heart Failure. N Engl J Med 2004;350:2140–50.
• Ellenbogen KA, Auricchio A, Burri H, et al. The evolving state of cardiac resynchronization therapy and conduction system pacing: 25 years of research at EP Europace journal. Europace Oxford University Press; 2023;25:1–16.
• Cha Y-M, Mulpuru SK. Cardiac Resynchronization Therapy Programming and Troubleshooting. Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy Elsevier; 2017. p. 1090–132.
• Burri H, Starck C, Auricchio A, et al. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and t. EP Eur 2021;23:1–26.
• Blomstrom-Lundqvist C, Ostrowska B. Prevention of cardiac implantable electronic device infections: guidelines and conventional prophylaxis. EP Eur 2021;23:iv11–9.

8. Indications for pacing in specific conditions

8.1. Transcatheter aortic valve implantation and post-cardiac surgery, hypertrophic cardiomyopathy, acute myocardial infarction, rare diseases (long QT syndrome, neuromuscular, congenital heart block, mitochondrial diseases, lamin mutation), inflammatory conditions (sarcoidosis), post-CIED infection, postcongenital reparative surgeries

• Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021;1–94.
• Lehtonen J, Uusitalo V, Pöyhönen P, et al. Cardiac sarcoidosis: phenotypes, diagnosis, treatment, and prognosis. Eur Heart J Oxford University Press; 2023;44:1495–510.
• KARPAWICH PP. Technical Aspects of Pacing in Adult and Pediatric Congenital Heart Disease. Pacing Clin Electrophysiol 2008;31:28–31.
• Sohail MR, Uslan DZ, Khan AH, et al. Management and Outcome of Permanent Pacemaker and Implantable Cardioverter-Defibrillator Infections. J Am Coll Cardiol 2007;49:1851–9.
• Qintar M, Morad A, Alhawasli H, et al. Pacing for drug-refractory or drug-intolerant hypertrophic cardiomyopathy. Cochrane Database Syst Rev 2012;2021.

9. Types and modes of pacing/defibrillator therapies

9.1. Endocardial pacing

• Mulpuru SK, Madhavan M, McLeod CJ, et al. Cardiac Pacemakers: Function, Troubleshooting, and Management. J Am Coll Cardiol 2017;69:189–210.
• Madhavan M, Mulpuru SK, McLeod CJ, et al. Advances and Future Directions in Cardiac Pacemakers. J Am Coll Cardiol 2017;69:211–35.

9.2. Epicardial pacing

• Mulpuru SK, Madhavan M, McLeod CJ, et al. Cardiac Pacemakers: Function, Troubleshooting, and Management. J Am Coll Cardiol 2017;69:189–210.
• Bristow MR, Saxon LA, Boehmer J, et al. Cardiac-Resynchronization Therapy with or without an Implantable Defibrillator in Advanced Chronic Heart Failure. N Engl J Med 2004;350:2140–50.

9.3. Conduction system pacing

• Ellenbogen KA, Auricchio A, Burri H, et al. The evolving state of cardiac resynchronization therapy and conduction system pacing: 25 years of research at EP Europace journal. Europace Oxford University Press; 2023;25:1–16.
• Vijayaraman P, Chelu MG, Curila K, et al. Cardiac Conduction System Pacing. JACC Clin Electrophysiol 2023;9:2358–87.
• Burri H, Jastrzebski M, Cano Ó, et al. EHRA clinical consensus statement on conduction system pacing implantation: endorsed by the Asia Pacific Heart Rhythm Society (APHRS), Canadian Heart Rhythm Society (CHRS), and Latin American Heart Rhythm Society (LAHRS). Europace Oxford University Press; 2023;25:1208–36.

9.4. Leadless pacing

• Ngo L, Nour D, Denman RA, et al. Safety and Efficacy of Leadless Pacemakers: A Systematic Review and Meta‐Analysis. J Am Heart Assoc 2021;10.
• Reddy VY, Exner D V., Cantillon DJ, et al. Percutaneous Implantation of an Entirely Intracardiac Leadless Pacemaker. N Engl J Med 2015;373:1125–35.

9.5. Pacing mode and rate responsive pacing

• Mulpuru SK, Madhavan M, McLeod CJ, et al. Cardiac Pacemakers: Function, Troubleshooting, and Management. J Am Coll Cardiol 2017;69:189–210.
• Madhavan M, Mulpuru SK, McLeod CJ, et al. Advances and Future Directions in Cardiac Pacemakers. J Am Coll Cardiol 2017;69:211–35.
• Świerżyńska E, Oręziak A, Główczyńska R, et al. Rate-Responsive Cardiac Pacing: Technological Solutions and Their Applications. Sensors 2023;23:1427.

10. ICDs

10.1. Transvenous ICD systems

• Moss AJ, Zareba W, Hall WJ, et al. Prophylactic Implantation of a Defibrillator in Patients with Myocardial Infarction and Reduced Ejection Fraction. N Engl J Med 2002;346:877–83.
• Moss AJ, Hall WJ, Cannom DS, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med 1996;335:1933–40.
• Buxton AE, Lee KL, Fisher JD, et al. A Randomized Study of the Prevention of Sudden Death in Patients with Coronary Artery Disease. N Engl J Med 1999;341:1882–90.
• Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005;352:225–37.
• Connolly SJ et al: Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials. European Heart Journal (2000) 21, 2071–2078 doi.10.1053/euhj.2000.2476

10.2. Subcutaneous and extravascular (non-transvenous) ICD systems

• Tonko JB, Rinaldi CA. Non-traditional implantable cardioverter-defibrillator configurations and insertion techniques: a review of contemporary options. EP Eur 2021;24:181–92.
• Knops RE, Olde Nordkamp LRA, Delnoy P-PHM, et al. Subcutaneous or Transvenous Defibrillator Therapy. N Engl J Med 2020;383:526–36.
• Friedman P, Murgatroyd F, Boersma LVA, et al. Efficacy and Safety of an Extravascular Implantable Cardioverter–Defibrillator. N Engl J Med 2022;387:1292–302.
• Fong KY, Ng CJR, Wang Y, et al. Subcutaneous Versus Transvenous Implantable Defibrillator Therapy: A Systematic Review and Meta‐Analysis of Randomized Trials and Propensity Score–Matched Studies. J Am Heart Assoc 2022;11.

11. Pacemakers and ICD systems

11.1. Pulse generator design and technology: batteries, capacitors, and electronic circuits

• Untereker DF, Schmidt C l., Jain G, et al. Power Sources and Capacitors for Pacemakers and Implantable Cardioverter-Defibrillators. Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy Elsevier; 2017. p. 251–69.

11.2. Ohms law, battery longevity

• Kay GN, Shepard RB. Stimulation and Excitation of Cardiac Tissues. Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy Elsevier; 2017. p. 61–113.

11.3. Pacemaker and ICD lead design and technology: structure and design of conductors, electrodes, and insulation

• Mulpuru SK, Madhavan M, McLeod CJ, et al. Cardiac Pacemakers: Function, Troubleshooting, and Management. J Am Coll Cardiol 2017;69:189–210.
• Helland JR, Mond HG, Muff D. Lead Connection Systems and Standards for Cardiac Implantable Electronic Devices. Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy Elsevier; 2017. p. 270–80.
• Lau EW. Leads and Electrodes for Cardiac Implantable Electronic Devices. Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy Elsevier; 2017. p. 313-351.e29.

11.4. Sensing, capture threshold, impedance, timing cycles, and EGMs

• Doppalapudi H. Timing Cycles of Implantable Devices. Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy Elsevier; 2017. p. 961–1030.
• Burri H, Israel CW, Deharo J-C. The EHRA Book of Pacemaker, ICD, and CRT Troubleshooting. Burri H, Israel C, Deharo J-C, eds. Oxford University Press; 2015.
• Burri H, Johansen JB, Linker N, Theuns DA. The EHRA Book of Pacemaker, ICD and CRT Troubleshooting Vol. 2. Oxford University PressOxford; 2022.

11.5. Pacemaker programming: timing cycles, blanking and refractory periods, common algorithms, minimization of ventricular pacing strategies, pacemaker-mediated tacycardia (PMT) and Repetitive nonreentrant ventriculoatrial synchrony (RNRVAS)

• Doppalapudi H. Timing Cycles of Implantable Devices. Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy Elsevier; 2017. p. 961–1030.
• Burri H, Israel CW, Deharo J-C. The EHRA Book of Pacemaker, ICD, and CRT Troubleshooting. Burri H, Israel C, Deharo J-C, eds. Oxford University Press; 2015.
• Burri H, Johansen JB, Linker N, Theuns DA. The EHRA Book of Pacemaker, ICD and CRT Troubleshooting Vol. 2. Oxford University PressOxford; 2022.

11.6. ICD programming: detection, discriminators, anti-tachycardia pacing and defibrillation therapy, common algorithms, programming for primary and secondary prevention, special considerations (young patients, athletes)

• Stiles MK, Fauchier L, Morillo CA, Wilkoff BL. 2019 HRS/EHRA/APHRS/LAHRS focused update to 2015 expert consensus statement on optimal implantable cardioverter‐defibrillator programming and testing. J Arrhythmia 2019;35:485–93.
• Wilkoff BL, Fauchier L, Stiles MK, et al. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Hear Rhythm Elsevier; 2016;13:e50–86.
• Moss AJ, Schuger C, Beck CA, et al. Reduction in Inappropriate Therapy and Mortality through ICD Programming. N Engl J Med 2012;367:2275–83.
• Heidbuchel H, Carre F. Exercise and competitive sports in patients with an implantable cardioverter-defibrillator. Eur Heart J 2014;35:3097–102.

11.7. Troubleshooting: types and mechanisms of lead noise, impedance change, loss of capture, inappropriate modes switch, T-wave and P-wave oversensing

• Mulpuru SK, Madhavan M, McLeod CJ, et al Cardiac Pacemakers: Function, Troubleshooting, and Management. J Am Coll Cardiol 2017;69:189–210.
• Swerdlow CD, Asirvatham SJ, Ellenbogen KA, Friedman PA. Troubleshooting Implanted Cardioverter Defibrillator Sensing Problems I. Circ Arrhythmia Electrophysiol 2014;7:1237–61.
• Swerdlow CD, Asirvatham SJ, Ellenbogen KA, Friedman PA. Troubleshooting Implantable Cardioverter-Defibrillator Sensing Problems II. Circ Arrhythmia Electrophysiol 2015;8:212–20.
• Swerdlow CD, Ploux S, Poole JE, et al. Interpreting device diagnostics for lead failure. Hear Rhythm Heart Rhythm Society; 2022;19:154–64.
• Dauw J, Dupont M, Martens P, et al. Cardiac device troubleshooting in the intensive care unit: an educational review. Eur Hear Journal Acute Cardiovasc Care 2021;

12.1. Schedule, systematic pacemaker and ICD check, optimal programming, CRT optimization, medication review

• Vernooy K, Deursen CJM van, Strik M, Prinzen FW. Strategies to improve cardiac resynchronization therapy. Nat Rev Cardiol Nature Publishing Group; 2014;11:481–93.
• Cha Y-M, Mulpuru SK. Cardiac Resynchronization Therapy Programming and Troubleshooting. Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy Elsevier; 2017. p. 1090–132.
• Varma N, Ricci R Pietro. Follow-Up of Cardiac Implantable Electronic Devices—Remote Monitoring and in Person. Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy Elsevier; 2017. p. 1133–57.

12.2. Remote monitoring, benefits, limitations, alert based

• Varma N, Ricci R Pietro. Follow-Up of Cardiac Implantable Electronic Devices—Remote Monitoring and in Person. Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy Elsevier; 2017. p. 1133–57.
• Reinhardt A, Ventura R. Remote Monitoring of Cardiac Implantable Electronic Devices: What is the Evidence? Curr Heart Fail Rep Springer US; 2023;20:12–23.
• Varma N, Epstein AE, Irimpen A, et al. Efficacy and Safety of Automatic Remote Monitoring for Implantable Cardioverter-Defibrillator Follow-Up. Circulation 2010;122:325–32.

13. Operating room considerations

13.1. CIED implant team: roles, team brief, and safety checks

13.2. Sterility and minimizing risk of infection

13.3. Radiation safety

13.4. Surgical instruments, optimal OR design and essential equipment

• Burri H, Starck C, Auricchio A, et al. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and t. EP Eur 2021;23:1–26.
• Blomstrom-Lundqvist C, Ostrowska B. Prevention of cardiac implantable electronic device infections: guidelines and conventional prophylaxis. EP Eur 2021;23:iv11–9.
• Tarakji KG, Mittal S, Kennergren C, et al. Antibacterial Envelope to Prevent Cardiac Implantable Device Infection. N Engl J Med 2019;380:1895–905.

14. CIED implant technique

14.1. Preprocedural planning

• Burri H, Starck C, Auricchio A, et al. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and t. EP Eur 2021;23:1–26.

14.2. Venous and cardiac anatomy, peripheral and central venous anatomy, CS anatomy and variations

• Atti V, Turagam MK, Garg J, et al. Subclavian and Axillary Vein Access Versus Cephalic Vein Cutdown for Cardiac Implantable Electronic Device Implantation: A Meta-Analysis. JACC Clin Electrophysiol. 2020 Jun;6(6):661-671.
• Mazur M, Żabówka A, Bolechała F, et al. Variations and angulation of the coronary sinus tributaries: Implications for left ventricular pacing. Pacing Clin Electrophysiol. 2019 Apr;42(4):423-430.
• Biffi M, Boriani G, Frabetti L, et al. Left superior vena cava persistence in patients undergoing pacemaker or cardioverter-defibrillator implantation: a 10-year experience. Chest 2001;120:139–44.

14.3. Surgical techniques

• Burri H, Starck C, Auricchio A, et al. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and t. EP Eur 2021;23:1–26
• Mair H, Jansens JL, Lattouf OM, et al. Epicardial lead implantation techniques for biventricular pacing via left lateral mini-thoracotomy, video-assisted thoracoscopy, and robotic approach. Heart Surg Forum. 2003;6(5):412-7.

14.4. Venous access techniques

• Burri H, Starck C, Auricchio A, et al. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and t. EP Eur 2021;23:1–26
• Atti V, Turagam MK, Garg J, et al. Subclavian and Axillary Vein Access Versus Cephalic Vein Cutdown for Cardiac Implantable Electronic Device Implantation: A Meta-Analysis. JACC Clin Electrophysiol. 2020 Jun;6(6):661-671.

14.5. Imaging for venous access

• Burri H, Starck C, Auricchio A, et al. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and t. EP Eur 2021;23:1–26
• Ferrari A, Saadi EK, Polanczyk CA. Axillary vein puncture guided by ultrasound vs cephalic vein dissection in pacemaker and defibrillator implant: A multicenter randomized clinical trial. Heart Rhythm. 2020 Sep;17(9):1554-1560

14.6. Lead implantation: techniques, choosing optimal implant site, fluoroscopic imaging (postero-anterior, right and left anterior oblique)

• Burri H, Starck C, Auricchio A, et al. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and t. EP Eur 2021;23:1–26

14.7. Options for dealing with difficult implants

• Burri H, Starck C, Auricchio A, et al. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and t. EP Eur 2021;23:1–26
• Mulpuru SK, Madhavan M, McLeod CJ, et al. Cardiac Pacemakers: Function, Troubleshooting, and Management. J Am Coll Cardiol 2017;69:189–210.

14.8. Intraprocedural testing: sensing, capture threshold, impedance, slew rate, injury current

• Burri H, Starck C, Auricchio A, et al. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and t. EP Eur 2021;23:1–26
• Barold SS, Stroobandt RX, Sinnaeve AF. Cardiac pacemakers and resynchronization step-by-step: An illustrated guide. 2nd ed. Pages: 10-58.

14.9. Defibrillation threshold and device programming

• Stiles MK, Fauchier L, Morillo CA, Wilkoff BL. 2019 HRS/EHRA/APHRS/LAHRS focused update to 2015 expert consensus statement on optimal implantable cardioverter‐defibrillator programming and testing. J Arrhythmia 2019;35:485–93.
• Wilkoff BL, Fauchier L, Stiles MK, et al. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Heart Rhythm Elsevier; 2016;13:e50–86.

14.10. Anaesthesia, analgesia, and safe sedation

• Burri H, Starck C, Auricchio A, et al. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and t. EP Eur 2021;23:1–26

14.11. Managing acute complications

• Burri H, Starck C, Auricchio A, et al. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and t. EP Eur 2021;23:1–26
• Mulpuru SK, Madhavan M, McLeod CJ, et al. Cardiac Pacemakers: Function, Troubleshooting, and Management. J Am Coll Cardiol 2017;69:189–210.

14.12. Special considerations for conduction system pacing, leadless pacemakers, subcutaneous and extravascular ICDs, and epicardial systems

• Mair H, Jansens JL, Lattouf OM, et al. Epicardial lead implantation techniques for biventricular pacing via left lateral mini-thoracotomy, video-assisted thoracoscopy, and robotic approach. Heart Surg Forum. 2003;6(5):412-7.
• Burri H, Jastrzebski M, Cano Ó, et al. EHRA clinical consensus statement on conduction system pacing implantation: endorsed by the Asia Pacific Heart Rhythm Society (APHRS), Canadian Heart Rhythm Society (CHRS), and Latin American Heart Rhythm Society (LAHRS). Europace Oxford University Press; 2023;25:1208–36.
• El-Chami MF, Shah AD. How to implant leadless pacemakers and mitigate major complications. Heart Rhythm. 2023 May;20(5):754-759.
• Brouwer TF, Miller MA, Quast AB, et al. Implantation of the Subcutaneous Implantable Cardioverter-Defibrillator: An Evaluation of 4 Implantation Techniques. Circ Arrhythm Electrophysiol. 2017 Jan;10(1):e004663.

15. Complications: indentification and management

• Burri H, Starck C, Auricchio A, et al. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and t. EP Eur 2021;23:1–26.

15.1. Acute: bleeding/haematoma, pneumothorax, lead displacement, cardiac perforation, allergy/anaphylaxis, infection

• Blomström-Lundqvist C, Traykov V, Erba PA, et al. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Europace. 2020 Apr 1;22(4):515-549.

15.2. Chronic: lead displacement, cardiac perforation, infection, exit block, lead failure

• Fuertes B, Toquero J, Arroyo-Espliguero R, Lozano IF. Pacemaker lead displacement: mechanisms and management. Indian Pacing Electrophysiol J. 2003 Oct 1;3(4):231-8

16. special considerations to minimize complications

16.1. Patient procedure selection to reduce lead complications

16.2. Perioperative considerations to minimize infection: antibiotic prophylaxis, draping, surgical technique, and operative environment

16.3. Perioperative management of anticoagulation

• Burri H, Starck C, Auricchio A, et al. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and t. EP Eur 2021;23:1–26
• Blomström-Lundqvist C, Traykov V, Erba PA, et al. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). 2020 Apr 1;22(4):515-549.
• Fuertes B, Toquero J, Arroyo-Espliguero R, Lozano IF. Pacemaker lead displacement: mechanisms and management. Indian Pacing Electrophysiol J. 2003 Oct 1;3(4):231-8

17. CIED extraction and lead management strategies

17.1. Management of non-functioning and abandoned leads

17.2. Indications for extraction

17.3. Extraction team and operation room requirements

17.4. Risk assessment, patient selection, and pre-procedure preparation

17.5. Extraction tools: sheaths, stylets, and snares

17.6. Management of complications

17.7. Lead specific considerations: lead design implications, dual coil, coil backfilling, co-radial design

• Bongiorni MG, Burri H, Deharo JC, et al. 2018 EHRA expert consensus statement on lead extraction: recommendations on definitions, endpoints, research trial design, and data collection requirements for clinical scientific studies and registries: endorsed by APHRS/HRS/LAHRS. Europace. 2018 Jul 1;20(7):1217.
• Hussein A.A., Tarakji K.G., Martin D.O.et al. : "Cardiac implantable electronic device infections: added complexity and suboptimal outcomes with previously abandoned leads". J Am Coll Cardiol EP 2017; 3: 1.
• Kwon S, Lee E, Choi EK, et al. Long-term outcomes of abandoned leads of cardiac implantable electronic devices. Heart Rhythm. 2023 Dec;20(12):1639-1646.
• Kusumoto FM, Schoenfeld MH, Wilkoff BL, et al. 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm. 2017 Dec;14(12):e503-e551.
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