2023 HRS/APHRS/LAHRS Guideline on Cardiac Physiologic Pacing for the Avoidance and Mitigation of Heart Failure

The aim of this clinical practice guideline is to provide guidance to clinical cardiac electrophysiologists, cardiologists, or other clinicians on the use of cardiac physiologic pacing, which includes cardiac resynchronization therapy and conduction system pacing, in patients with indications for pacemakers or heart failure. Heart failure is a leading cause of morbidity and mortality and is responsible for significant health care costs. Cardiac resynchronization therapy has been shown to reduce heart failure symptoms and improve heart function and survival rates in select patients. Over the past few years, new data have emerged on the optimization of pacing techniques and new pacing-related therapies to improve survival in patients with heart failure. With recent advances in technology, conduction system pacing has emerged as a potential alternative to traditional pacing and cardiac resynchronization therapy. This guideline evaluates theses new advances and provides evidence-based recommendations on pacing practices in patients with heart failure.