European Heart Journal Advance Access originally published online on August 28, 2007
European Heart Journal 2007 28(18):2256-2295; doi:10.1093/eurheartj/ehm305
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Guidelines for cardiac pacing and cardiac resynchronization therapy
The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association
Authors/Task Force Members,
(Greece)
(Switzerland)
(France)
(France)
(Germany)
(Belgium)
(Italy)
(Sweden)
(Portugal)
(Turkey)
(UK)
(Poland)
ESC Committee for Practice Guidelines (CPG),
(France)
(UK)
(Italy)
(France)
(Norway)
(France)
(Greece)
(The Netherlands)
(Denmark)
(France)
(Germany)
(Germany)
(Poland)
(Czech Republic)
(Spain)
Document Reviewers,
(Italy)
(Sweden)
(Italy)
(Spain)
(UK)
(Spain)
(UK)
(Spain)
(Switzerland)
(France)
(UK)
(Spain)
(Italy)
(France)
(The Netherlands)
(Germany)
* Corresponding author: Panos Vardas, Department of Cardiology, Heraklion University Hospital, PO Box 1352 Stavrakia, GR-711 10 Heraklion (Crete), Greece. Tel: +30 2810 392706; fax: +30 2810 542 055; e-mail: cardio@med.uoc.gr
List of Abbreviations: ASSENT-II, Assessment of the Safety and Efficacy of a New Thrombolytic trial • BELIEVE, The Bi vs Left Ventricular Pacing: an International Pilot Evaluation on Heart Failure Patients with Ventricular Arrhythmias multicentre prospective randomized pilot study • CARE-HF, The Cardiac Resynchronization-Heart Failure trial • COMPANION, Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure trial • CTOPP, Canadian Trial of Physiological Pacing • DANPACE, Danish Multicenter Randomized Study on Atrial Inhibited versus Dual-Chamber Pacing in Sick Sinus Syndrome • DAVID, Dual Chamber and VVI Implantable Defibrillator trial • GUSTO-I, Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries-I • GUSTO-III, Global Use of Strategies to Open Occluded Coronary Arteries-III • ISSUE 2, International Study on Syncope of Uncertain Etiology 2 • MILOS, Multicenter Longitudinal Observational Study • MIRACLE, Multicenter InSync Randomized Clinical Evaluation trial • MIRACLE ICD II, Multicenter InSync ICD Randomized Clinical Evaluation trial • MOST, Mode Selection Trial • MUSTIC, Multisite Stimulation in Cardiomyopathy study • OPSITE, Optimal Pacing SITE study • PASE, Pacemaker Selection in the Elderly trial • PATH CHF, Pacing Therapies in Congestive Heart Failure study • PAVE, Left Ventricular-Based Cardiac Stimulation Post AV Nodal Ablation Evaluation • SCD-HeFT, Sudden Cardiac Death in Heart Failure Trial • SYDIT, Syncope Diagnosis and Treatment study • SYNPACE, Vasovagal Syncope and Pacing trial • UKPACE, United Kingdom Pacing and Cardiovascular Events trial • VASIS, The Vasovagal Syncope International Study • VPS, North American Vasovagal Pacemaker Study
The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained upon submission of a written request to Oxford University Press, the publisher of the European Heart Journal and the party authorized to handle such permissions on behalf of the ESC.
Disclaimer. The ESC Guidelines represent the views of the ESC and were arrived at after careful consideration of the available evidence at the time they were written. Health professionals are encouraged to take them fully into account when exercising their clinical judgement. The guidelines do not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patients, in consultation with that patient, and
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Preamble |
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Introduction |
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Pacing in bradyarrhythmia, syncope, and other specific conditions
Cardiac resynchronization therapy
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1. Pacing in arrhythmias |
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1.1. Sinus node disease
1.1.1. Indications for pacing in sinus node disease
1.1.2. Choice of the pacing mode for patients with sinus node disease
1.2. Atrioventricular and intraventricular conduction disturbances
1.2.1. Indications for pacing
1.2.2. Acquired atrioventricular block in special cases
1.2.3. Pacing for chronic bifascicular and trifascicular block
1.2.4. Indications for pacing
1.2.5. Choice of pacing mode for patients with atrioventricular block
1.3. Recent myocardial infarction
1.3.1. Pacing in conduction disturbances related to acute myocardial infarction
1.4. Reflex syncope
1.4.1. Carotid sinus syndrome
1.4.1.1. Indications for pacing in carotid sinus syndrome
1.4.1.2. Choice of the pacing mode in carotid sinus syndrome
1.4.2. Vasovagal syncope
1.4.2.1. Non-pacing therapy in vasovagal syncope
1.4.2.2. Indications for pacing in vasovagal syncope
1.4.3. Adenosine-sensitive syncope
1.5. Paediatrics and congenital heart diseases
1.5.1. Sinus node dysfunction and bradycardia–tachycardia syndrome at young ages
1.5.2. Congenital atrioventricular block
1.5.3. Atrioventricular block and cardiac surgery
1.5.4. Long QT syndrome
1.5.5. Adults with congenital heart disease
1.5.6. Device and mode selection
1.6. Cardiac transplantation
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2. Pacing for specific conditions |
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2.1. Hypertrophic cardiomyopathy
2.1.1. The rationale for short atrioventricular delay DDD pacing in hypertrophic obstructive cardiomyopathy
2.1.1.1. Clinical effects of short atrioventricular delay DDD pacing in hypertrophic obstructive cardiomyopathy
2.1.2. Therapy delivery and programming
2.1.3. Indications for pacing in hypertrophic obstructive cardiomyopathy
2.2. Sleep apnoea
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3. Cardiac resynchronization therapy in patients with heart failure |
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3.1. Introduction
3.1.1. Rationale of cardiac resynchronization
3.1.2. Evidence-based clinical effects of cardiac resynchronization therapy
3.1.2.1. Impact of cardiac resynchronization therapy on symptoms and exercise tolerance
3.1.2.2. Impact of cardiac resynchronization therapy on heart failure-related major morbidity
3.1.2.3. Impact of cardiac resynchronization therapy on mortality
3.1.2.4. Impact of cardiac resynchronization therapy on cardiac function and structure
3.1.3. Cost-effectiveness issues
3.1.4. Unresolved issues
3.1.4.1. Patient selection: electrical or electromechanical dyssynchrony criteria to select patients for cardiac resynchronization therapy?
3.1.4.2. Patients with atrial fibrillation
3.1.4.3. Patients with mild heart failure or asymptomatic left ventricular systolic dysfunction (New York Heart Association classes I–II)
3.1.4.4. Pacing in heart failure in the paediatric population
3.1.4.5. Device selection: cardiac resynchronization therapy in combination with implantable cardioverter defibrillator therapy (CRT-D) or cardiac resynchronization therapy alone?
3.1.4.6. Biventricular pacing or left ventricular pacing alone?
3.1.4.7. Patients with indication for permanent pacing for bradyarrhythmia, with heart failure symptoms and severely compromised left ventricular function
3.1.4.8. Patients with a previously implanted conventional pacing device and severe left ventricular dysfunction
3.1.4.9. Patients with indication for biventricular pacing who must undergo heart surgery
3.1.5. Programming recommendations
3.2. Recommendations
3.2.1. Recommendations for the use of cardiac resynchronization therapy by biventricular pacemaker (CRT-P) or biventricular pacemaker combined with an implantable cardioverter defibrillator (CRT-D) in heart failure patients
3.2.2. Recommendations for the use of biventricular pacing in heart failure patients with a concomitant indication for permanent pacing
3.2.3 Recommendations for the use of an implantable cardioverter defibrillator combined with biventricular pacemaker (CRT-D) in heart failure patients with an indication for an implantable cardioverter defibrillator
3.2.4 Recommendations for the use of biventricular pacing in heart failure patients with permanent atrial fibrillation
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Abbreviations |
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Clinical trial acronyms |
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Appendix A |
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pacemaker follow-up
The main objectives, structure, and function of the pacemaker clinic
Pre-discharge assessment and long-term follow-up methodology
Complications, failures, and side effects of pacemaker treatment
Special issues related to the paced patient's life
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Appendix B |
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technical considerations and requirements for implanting cardiac resynchronization therapy devices
Technical and personnel requirements for centres intending to implant cardiac resynchronization therapy devices
Scheduling patient for cardiac resynchronization therapy
Characterization of coronary sinus anatomy
Requirements for the operating theatre
Personnel requirements during cardiac resynchronization therapy implantation
Clinical competence for implanting cardiac resynchronization therapy devices
Minimum training for competence
Maintenance of competence
Further practical cardiac resynchronization therapy implant recommendations
Follow-up
Long-term follow-up
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Footnotes |
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References |
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K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, A. W. Hoes, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM) Eur J Heart Fail, October 1, 2008; 10(10): 933 - 989. [Full Text] [PDF]
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M.J. P. Raatikainen, P. Uusimaa, M. M.E. van Ginneken, J. P.G. Janssen, and M. Linnaluoto Remote monitoring of implantable cardioverter defibrillator patients: a safe, time-saving, and cost-effective means for follow-up Europace, October 1, 2008; 10(10): 1145 - 1151. [Abstract] [Full Text] [PDF]
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C. Valzania, M. J. Eriksson, G. Boriani, and F. Gadler Cardiac resynchronization therapy during rest and exercise: comparison of two optimization methods Europace, October 1, 2008; 10(10): 1161 - 1169. [Abstract] [Full Text] [PDF]
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F. Braunschweig, I. Ford, V. Conraads, M. R. Cowie, G. Jondeau, J. Kautzner, M. Lunati, R. M. Aguilera, C. M. Yu, M. Marijianowski, et al. Can monitoring of intrathoracic impedance reduce morbidity and mortality in patients with chronic heart failure? Rationale and design of the Diagnostic Outcome Trial in Heart Failure (DOT-HF) Eur J Heart Fail, September 1, 2008; 10(9): 907 - 916. [Abstract] [Full Text] [PDF]
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M. Sterlinski, C. Sosnowski, D. Zajac, W. Ruzyllo, and H. Szwed Is coronary vein angioplasty necessary to provide cardiac resynchronization in selected patients? A case report Europace, September 1, 2008; 10(9): 1116 - 1118. [Abstract] [Full Text] [PDF]
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F. W. Prinzen and A. Auricchio Is echocardiographic assessment of dyssynchrony useful to select candidates for cardiac resynchronization therapy?: Echocardiography Is Not Useful Before Cardiac Resynchronization Therapy if QRS Duration Is Available Circ Cardiovasc Imaging, July 1, 2008; 1(1): 70 - 78. [Full Text] [PDF]
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C. Leclercq and P. Mabo Cardiac resynchronization therapy and atrial fibrillation. Do we have a final answer? Eur. Heart J., July 1, 2008; 29(13): 1597 - 1599. [Full Text] [PDF]
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F. Osman, K. Ratib, S. Krishnamoorthy, A. Nadir, J. Creamer, and A. Morley-Davies Temporary pacing wire in the coronary sinus: a novel treatment of acute heart failure? Europace, July 1, 2008; 10(7): 877 - 879. [Abstract] [Full Text] [PDF]
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K. Goscinska-Bis, J. Bis, M. Krejca, R. Ulczok, P. Szmagala, A. Bochenek, and W. Kargul Totally epicardial cardiac resynchronization therapy system implantation in patients with heart failure undergoing CABG Eur J Heart Fail, May 1, 2008; 10(5): 498 - 506. [Abstract] [Full Text] [PDF]
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A. Auricchio and F. W. Prinzen Cardiac Resynchronization Therapy: The More Pacing Sites, the Better the Outcome? J. Am. Coll. Cardiol., April 15, 2008; 51(15): 1463 - 1465. [Full Text] [PDF]
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J. C. Daubert Modulation of cardiac contractility. A potential treatment of heart failure? Eur. Heart J., April 2, 2008; 29(8): 961 - 963. [Full Text] [PDF]
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S. K.H. Lam and A. Owen What is the level of evidence for combined cardiac resynchronization and defibrillation therapy in heart failure? Eur. Heart J., March 1, 2008; 29(5): 682 - 683. [Full Text] [PDF]
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P. E. Vardas, A. Auricchio, J.-J. Blanc, J.-C. Daubert, H. Drexler, H. Ector, M. Gasparini, C. Linde, F. B. Morgado, A. Oto, et al. What is the level of evidence for combined cardiac resynchronization and defibrillation therapy in heart failure? reply Eur. Heart J., March 1, 2008; 29(5): 683 - 684. [Full Text] [PDF]
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S. J. Cazeau, J-C. Daubert, L. Tavazzi, G. Frohlig, and V. Paul Responders to cardiac resynchronization therapy with narrow or intermediate QRS complexes identified by simple echocardiographic indices of dyssynchrony: The DESIRE study Eur J Heart Fail, March 1, 2008; 10(3): 273 - 280. [Abstract] [Full Text] [PDF]
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