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Pacemaker and ICD Programming Adherence With Evidence-Based Recommendations.

Alexander Smith1, Matthew Ortman1, John Andriulli1

  • 1Cooper Medical School of Rowan University, Camden, New Jersey, USA.

Journal of Cardiovascular Electrophysiology
|January 10, 2026
PubMed
Summary
This summary is machine-generated.

Despite expert guidelines, optimal pacemaker and ICD programming remains a challenge. This study found no improvement in adherence to consensus recommendations post-guideline update, highlighting a gap between guidelines and practice.

Keywords:
BiV pacingICD programmingadherence

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Area of Science:

  • Cardiology
  • Medical Devices
  • Clinical Practice Guidelines

Background:

  • Expert consensus guidelines for pacemaker (PPM) and implantable cardioverter-defibrillator (ICD) programming exist.
  • Real-world adherence to these data-driven recommendations is often suboptimal.
  • A gap persists between recommended and actual device programming practices.

Purpose of the Study:

  • To evaluate adherence to 2015 expert consensus guidelines for pacemaker and ICD programming.
  • To determine if adherence improved after the consensus statement update.
  • To analyze device programming data before and after guideline implementation.

Main Methods:

  • Retrospective, observational, single-center study of device implant registry data.
  • Compared programming parameters for single, dual, or biventricular (BiV) devices pre- (2012-2013) and post- (2020-2022) consensus.
  • Assessed BiV pacing percentage (>98%) and ICD bradycardia/tachyarrhythmia settings (Medtronic devices only).

Main Results:

  • Biventricular pacing adherence decreased post-consensus (85.4% to 58.0% for >98% pacing).
  • ICD bradycardia pacing adherence remained similar (89.5% vs. 90.1%).
  • A trend towards improved tachyarrhythmia adherence was observed (39.5% vs. 45.7%), significantly increasing if SVT logic was excluded.

Conclusions:

  • Real-world adherence to pacemaker and ICD programming guidelines shows a persistent disconnect.
  • Current clinical practice does not fully align with data-driven recommendations.
  • Further research is needed to understand physician barriers to guideline implementation.