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May 20, 2023Heart Rhythm532 citationsOpen Access

2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure

MCMina K. ChungKPKristen K. PattonCLChu‐Pak Lau

Key Result

Cardiac physiologic pacing, encompassing cardiac resynchronization therapy and conduction system pacing, is recommended to mitigate or prevent heart failure in patients requiring substantial ventricular pacing.

Structured PICO

P
Population
Patients with pacemaker indications or heart failure, ventricular dyssynchrony, or pacing-induced cardiomyopathy, including pediatric populations
I
Intervention
Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP)

Provides updated clinical practice guidelines on cardiac physiologic pacing (CRT and CSP) for avoiding and mitigating heart failure.

Limitations

  • True incidence and prevalence of electrical dyssynchrony-induced heart failure and cardiomyopathy remain unclear
  • Long-term data regarding outcomes and safety for conduction system pacing (LBBAP and HBP) are lacking
  • His bundle pacing has a substantial incidence of rising thresholds and lead revisions

Abstract

Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.

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Cite This Study

Chung et al. (2023) conducted a review in Heart failure, ventricular dyssynchrony, and pacing-induced cardiomyopathy. Cardiac physiologic pacing (CRT, HBP, LBBAP) vs. Right ventricular pacing was evaluated. Cardiac physiologic pacing, encompassing cardiac resynchronization therapy and conduction system pacing, is recommended to mitigate or prevent heart failure in patients requiring substantial ventricular pacing.

synapsesocial.com/papers/6aa204fa01abe00586ef9ea7https://doi.org/10.1016/j.hrthm.2023.03.1538
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