[ESC Guidelines on Pacemaker Therapy 2013: what is new and relevant for daily practice?]

The European Society of Cardiology (ESC) and the European Heart Rhythm Association (EHRA) published new guidelines for pacemaker and cardiac resynchronisation therapy in June 2013. The most important recommendations for daily clinical practice of pacemaker therapy firstly refer to the diagnosis of bradycardia and bradycardia-symptom-correlation. Bradycardia is classified into persistent and intermittent, the latter with and without documentation of spontaneous bradycardia. Evidence for pacemaker therapy depends on the quality of bradycardia-symptom-correlation. The indication for pacing in sick-sinus-syndrome and AV block is significantly simplified and the use of implantable loop-recording in syncope of unknown origin encouraged. If loop recorders document long asymptomatic pauses, the authors felt that an indication for pacing exists if pauses exceed 6 sec. Other newly defined pacing indications are syncope in bundle branch block and very long PR (> 300 ms), particularly in older patients and those with structural heart disease. New insights and recommendations are further provided for complications of pacemaker therapy, right ventricular pacing sites, perioperative anticoagulation, pacing and magnetic resonance imaging and remote monitoring. In conclusion, the new ESC guidelines elegantly summarize results of new trials and studies in bradycardia and pacemaker therapy and provide valuable recommendations for daily practice.