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International recommendations on pacemaker selection

An expert consensus statement on pacemaker device and mode selection1 has recently been released by the Heart Rhythm Society (HRS) and the American College of Cardiology Foundation (ACCF).

The statement expands upon the ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities, reviewing the field and reporting consensus recommendations on pacemaker device and mode selection.

It provides a guide to the appropriate use of single vs. dual-chamber devices for patients who already meet guidelines for pacemaker implantation when a clinical decision for pacing has been made. It also includes recommendations for conditions for which there is evidence or general agreement that a given pacing mode is beneficial, useful and effective. This includes conditions for which there is conflicting evidence about the usefulness of a specific pacing mode.

“As new clinical data emerges and technology advances, it is important that clinicians and researchers collaborate to update our knowledge and ensure the best quality of care is delivered,” stated co-lead author, Dr Anne M Gillis, president of the Heart Rhythm Society. “This document represents the first recommendations specific to pacing devices and mode selection for the individual patient and provides a framework for clinicians and healthcare administrators to select the best possible therapy to optimise patient outcomes”.

The HRS and ACCF convened a diverse panel of 11 cardiac electrophysiologists and surgeons from the United States, Canada and Europe. The writing group reviewed outcomes of pacing mode selection for patients with sinus node dysfunction (SND), atrioventricular (AV) conduction block and other less common indications for pacing.

Collectively, the consensus experts recommend that patients with SND may benefit from atrial or dual-chamber pacing compared with ventricular pacing in regards to the risks of atrial fibrillation (AF), stroke, pacemaker syndrome and improved quality of life. In patients with AV block, dual-chamber pacing can reduce the incidence of pacemaker syndrome and improve some indexes of quality of life. Furthermore, recommending dual chamber pacing or single chamber atrial pacing should not be used in patients in permanent or longstanding persistent AF.

Specific recommendations for cardiac resynchronisation therapy are not addressed in this document as they are currently provided in previously published guidelines.

References

1. Gillis AM, Russo AM, Ellenbogen KA, et al. HRS/ACCF Expert Consensus Statement on pacemaker device and mode selection : developed in partnership between the Heart Rhythm Society (HRS) and the American College of Cardiology Foundation (ACCF) and in collaboration with the Society of Thoracic Surgeons. Heart Rhythm 2012;9:1344–65. http://dx.doi.org/10.1016/j.hrthm.2012.06.026

Published on: August 24, 2012

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