2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure
Mina K Chung1, Kristen K Patton2, Chu-Pak Lau3
1Cleveland Clinic Cleveland Ohio USA.
Insights
Cardiac physiologic pacing (CPP), including cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), offers a strategy to prevent heart failure (HF). This guideline details CPP indications, patient selection, and management for optimal outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Cardiac physiologic pacing (CPP), comprising cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), is a therapeutic approach.
- It aims to mitigate or prevent heart failure (HF) in patients experiencing ventricular dyssynchrony or pacing-induced cardiomyopathy.
Purpose of the Study:
- To provide a clinical practice guideline for CPP, focusing on CRT for HF and CPP in patients with pacemaker indications or HF.
- To guide patient selection, pre-procedure evaluation, implant management, and follow-up optimization.
- To address the use of CPP in pediatric populations and identify research gaps.
Main Methods:
- Guideline development based on current clinical evidence and expert consensus.
- Comprehensive review of indications, patient selection criteria, and procedural aspects of CRT and CSP.
- Inclusion of pediatric considerations and future research directions.
Main Results:
- Establishes indications for CRT in HF therapy.
- Outlines strategies for CPP in patients requiring pacemakers or with existing HF.
- Provides a framework for patient evaluation, implantation, and post-procedure management.
- Identifies areas for future research in cardiac pacing.
Conclusions:
- CPP, including CRT and CSP, represents a significant advancement in managing heart failure and preventing cardiac dysfunction.
- This guideline offers a comprehensive approach to CPP implementation, from patient selection to long-term management.
- Further research is needed to fully elucidate the potential of CPP across diverse patient populations.
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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