2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy

Abstract

Disclaimer:The ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgement, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and in consultation with that patient and, where appropriate and/or necessary, the patient's caregiver. Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.

Syncope: new solutions for an old problem

“…The results of the multicentre randomized placebo-controlled BIOSync trial have reinforced this conclusion, showing a significantly lower risk of (pre)syncope recurrence in patients with cardioinhibitory positive TT receiving dual-chamber pacing with closedloop stimulation compared with pacing-off (a 77% and 46% relative and absolute risk reduction at 2 years, respectively) [77]. Based on this evidence, the guidelines of the European Society of Cardiology (ESC) have upgraded the indication for pacing in reflex syncope from IIb to I [78]. It must be understood that cardiac pacing is not always necessary but only indicated in patients aged >40-years affected by severe, recurrent, unpredictable syncope (i.e., often without prodrome) associated with a high risk of injuries [78].…”

“…Based on this evidence, the guidelines of the European Society of Cardiology (ESC) have upgraded the indication for pacing in reflex syncope from IIb to I [78]. It must be understood that cardiac pacing is not always necessary but only indicated in patients aged >40-years affected by severe, recurrent, unpredictable syncope (i.e., often without prodrome) associated with a high risk of injuries [78]. At present, there is no evidence to support pacing in patients <40-years presenting even with severe symptoms [78] Patients indicated for pacing can be identified by a multistep diagnostic pathway including CSM, TT, and ILR, as recommended by ESC guidelines [78].…”

Management of Advanced Heart Failure in Children with Cancer Therapy-Related Cardiac Dysfunction

“…CRT is recommended for adult patients with symptomatic heart failure despite medical therapy in sinus rhythm with LVEF < 35%, QRS duration >150 msec, and left bundle branch block (LBBB) QRS morphology. CRT can also be considered for symptomatic patients with LVEF < 35% with intermediate QRS duration and/or non-LBBB QRS morphology [38][39][40][41].…”

Impact of COVID-19 Pandemic on Cardiac Electronic Device Management and Role of Remote Monitoring

“…Indeed, in the new guidelines of the European Society of Cardiology (ESC) on cardiac pacing, RM is recommended to reduce the number of in-office follow-up in patients with pacemaker (PMK) who have difficulties to attend in-person visits. RM may also be useful in case of a device component that has been recalled or is on advisory, to enable early detection of actionable events in patients at high risk [ 18 ]. RM provide the same information of an in-person visit ensuring an early identification of cardiac arrhythmias, such as ventricular tachycardias or atrial fibrillation, device therapy and device-related issues like lead malfunction and early battery discharge [ 19 , 20 , 21 , 22 ].…”

“…Although guidelines recommended the use of RM for the follow-up of patients with CIED, the coverage of RM was limited due to the organizational problems of healthcare systems and reimbursement issues [ 18 , 20 ]. The COVID-19 pandemic forced all healthcare providers to minimize interpersonal contacts to limit the spread of the virus, which led to a total reshaping of outpatient cardiology management and accelerated the deployment and widespread use of RM [ 24 ].…”