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Guidelines cardiac-pacing-slides

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  • 1. Committee for Practice Guidelines (CPG) 1Committee for Practice Guidelines (CPG) 1Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 11 Guidelines for Cardiac Pacing and Cardiac Resynchronisation Therapy The Task Force for Cardiac Pacing and Cardiac Resynchronisation Therapy of the European Society of Cardiology Developed in collaboration with the European Heart Rhythm Association
  • 2. Committee for Practice Guidelines (CPG) 2Committee for Practice Guidelines (CPG) 2Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 22 Authors/Task Force Members Angelo Auricchio (Switzerland) Jean-Jacques Blanc (France) Jean-Claude Daubert (France) Helmut Drexler (Germany) Hugo Ector (Belgium) Maurizio Gasparini (Italy) Cecilia Linde (Sweden) Francisco Bello Morgado (Portugal) Ali Oto (Turkey) Richard Sutton (UK) Maria Trusz-Gluza (Poland) Chairperson: Panos E. Vardas (Greece)
  • 3. Committee for Practice Guidelines (CPG) 3Committee for Practice Guidelines (CPG) 3Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 33
  • 4. Committee for Practice Guidelines (CPG) 4Committee for Practice Guidelines (CPG) 4Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 44 Introduction • The guidelines for the appropriate use of pacemaker devices presented in this document, a joint ESC and EHRA initiative, aim to provide for the first time in Europe an up to date specialists' view of the field. • The guidelines cover two main areas: the first includes permanent pacing in bradyarrhythmias, syncope, and other specific conditions, while the second refers to ventricular resynchronisation as an adjunct therapy in patients with heart failure.
  • 5. Committee for Practice Guidelines (CPG) 5Committee for Practice Guidelines (CPG) 5Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 55 Classes of Recommendations
  • 6. Committee for Practice Guidelines (CPG) 6Committee for Practice Guidelines (CPG) 6Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 66 Levels of Evidence
  • 7. Committee for Practice Guidelines (CPG) 7Committee for Practice Guidelines (CPG) 7Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 77 1. Pacing for Arrhythmias
  • 8. Committee for Practice Guidelines (CPG) 8Committee for Practice Guidelines (CPG) 8Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 88 1.1. Sinus node disease Recommendations for cardiac pacing in sinus node disease
  • 9. Committee for Practice Guidelines (CPG) 9Committee for Practice Guidelines (CPG) 9Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 99 Pacemaker mode selection in sinus node disease
  • 10. Committee for Practice Guidelines (CPG) 10Committee for Practice Guidelines (CPG) 10Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 1010 1.2. Atrioventricular and intraventricular conduction disturbances Recommendations for cardiac pacing in acquired AV block
  • 11. Committee for Practice Guidelines (CPG) 11Committee for Practice Guidelines (CPG) 11Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 1111 1.2. Atrioventricular and intraventricular conduction disturbances Recommendations for cardiac pacing in chronic bi- and tri-fascicular block
  • 12. Committee for Practice Guidelines (CPG) 12Committee for Practice Guidelines (CPG) 12Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 1212 Pacemaker mode selection in acquired atrioventricular block, chronic bifascicular and trifascicular block
  • 13. Committee for Practice Guidelines (CPG) 13Committee for Practice Guidelines (CPG) 13Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 1313 1.3. Recent myocardial infarction Recommendations for permanent cardiac pacing in conduction disturbances related to acute myocardial infarction
  • 14. Committee for Practice Guidelines (CPG) 14Committee for Practice Guidelines (CPG) 14Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 1414 1.4. Reflex syncope The main causes of reflex syncope
  • 15. Committee for Practice Guidelines (CPG) 15Committee for Practice Guidelines (CPG) 15Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 1515 Recommendations for cardiac pacing in carotid sinus syndrome
  • 16. Committee for Practice Guidelines (CPG) 16Committee for Practice Guidelines (CPG) 16Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 1616 Recommendations for cardiac pacing in vasovagal syncope
  • 17. Committee for Practice Guidelines (CPG) 17Committee for Practice Guidelines (CPG) 17Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 1717 1.5. Paediatrics and congenital heart diseases Recommendations for cardiac pacing in paediatrics and congenital heart disease
  • 18. Committee for Practice Guidelines (CPG) 18Committee for Practice Guidelines (CPG) 18Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 1818 1.5. Paediatrics and congenital heart diseases Recommendations for cardiac pacing in paediatrics and congenital heart disease
  • 19. Committee for Practice Guidelines (CPG) 19Committee for Practice Guidelines (CPG) 19Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 1919 1.5. Paediatrics and congenital heart diseases Recommendations for cardiac pacing in paediatrics and congenital heart disease
  • 20. Committee for Practice Guidelines (CPG) 20Committee for Practice Guidelines (CPG) 20Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 2020 1.6. Cardiac transplantation Recommendations for cardiac pacing after cardiac transplantation
  • 21. Committee for Practice Guidelines (CPG) 21Committee for Practice Guidelines (CPG) 21Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 2121 2. Pacing for Specific Conditions
  • 22. Committee for Practice Guidelines (CPG) 22Committee for Practice Guidelines (CPG) 22Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 2222 2.1. Hypertrophic cardiomyopathy Recommendations for cardiac pacing in hypertrophic cardiomyopathy
  • 23. Committee for Practice Guidelines (CPG) 23Committee for Practice Guidelines (CPG) 23Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 2323 3. Cardiac Resynchronisation Therapy (CRT) in Patients with Heart Failure • State-of-the-art management of congestive heart failure (CHF), besides alleviating symptoms, preventing major morbidity, and lowering mortality, increasingly strives to prevent disease progression, in particularly the transition between asymptomatic LV dysfunction and overt CHF. • The clinical effects of long-term CRT were firstly evaluated in non- controlled studies, in which a sustained benefit conferred by biventricular pacing was measured. Randomized multi-centre trials with crossover or parallel treatment assignments were subsequently conducted to ascertain the clinical value of CRT in patients with advanced CHF and in sinus rhythm, with or without indications for an implantable cardioverter- defibrillator (ICD). Meta-analyses were also published. • The usual study enrolment criteria were: 1) CHF in New York Heart Association (NYHA) functional Class III or IV despite optimal pharmacological treatment; 2) LV ejection fraction (EF) < 35%, LV end- diastolic diameter > 55 mm, and QRS duration ≥ 120 or 150 ms. Evidence-based clinical effects of CRT
  • 24. Committee for Practice Guidelines (CPG) 24Committee for Practice Guidelines (CPG) 24Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 2424 • Pacing for heart failure can be applied either by biventricular pacing or, in selected cases, by left ventricular pacing alone. The following recommendations consider cardiac pacing for heart failure delivered through biventricular pacing, since this mode is supported by the greatest body of evidence. This, however, does not preclude other pacing modes, such as LV pacing, to correct ventricular dyssynchrony. • Ventricular conduction delay continues to be defined according to QRS duration (QRS ≥ 120 ms). It is recognised that ventricular conduction delay may not result in mechanical dyssynchrony. Dyssynchrony is defined as an uncoordinated regional contraction-relaxation pattern. Although from the theoretical point of view it may be more appropriate to target mechanical dyssynchrony, rather than electrical conduction delay, no large controlled study has prospectively assessed the value of mechanical dyssynchrony in heart failure patients undergoing pacing for heart failure. 3. Cardiac Resynchronisation Therapy (CRT) in Patients with Heart Failure Recommendations
  • 25. Committee for Practice Guidelines (CPG) 25Committee for Practice Guidelines (CPG) 25Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 2525 3. Cardiac Resynchronisation Therapy (CRT) in Patients with Heart Failure
  • 26. Committee for Practice Guidelines (CPG) 26Committee for Practice Guidelines (CPG) 26Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 2626 3. Cardiac Resynchronisation Therapy (CRT) in Patients with Heart Failure
  • 27. Committee for Practice Guidelines (CPG) 27Committee for Practice Guidelines (CPG) 27Guidelines for Cardiac Pacing and CRT Slide-SetGuidelines for Cardiac Pacing and CRT Slide-SetCardiac Pacing and CRT Guidelines Slide-set © European Society of CardiologyCardiac Pacing and CRT Guidelines Slide-set © European Society of Cardiology 2727 3. Cardiac Resynchronisation Therapy (CRT) in Patients with Heart Failure