HRS, APHRS, and LAHRS Release Cardiac Physiological Pacing Guideline

New guidance covers recommendations on pacing device indications, pre/during/post implant evaluations, and optimization of pacing response in adults and children

New Orleans, LA, May 20, 2023 – Today, the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Latin American Heart Rhythm Society (LAHRS) released a new clinical practice guideline on cardiac physiologic pacing strategies to restore ventricular synchrony and improve cardiac performance. The 2023 HRS/APHRS/LAHRS Guideline on Cardiac Physiologic Pacing for the Avoidance and Mitigation of Heart Failure is intended 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.

"The field of physiologic pacing has undergone significant expansion and these technological advancements gave rise to questions regarding patient selection, indications, and follow-up procedures," said Mina K. Chung, MD, FHRS from the Cleveland Clinic and Chair of the guideline. "We hope that this guideline answers those questions and provides evidence-based practical guidance on pacing practices in patients with heart failure."

Throughout the guideline, the authors emphasize the importance of shared decision-making between providers and patients when considering treatment with a CPP device. These discussions should account for the patient's values, preferences, and care goals, while considering the potential advantages and risks associated with the pacing therapy. In addition, the authors acknowledge there remain critical gaps in our current understanding within the field and highlight novel directions for future research.

"More randomized trials and long-term data are required, specifically around clinical outcomes from conduction system pacing," said Kristen K. Patton, MD, FHRS from the University of Washington and Vice-Chair of the guideline. "We've identified several areas for future study, and we hope this document will serve as a valuable guide for researchers and industry partners involved in the advancement of these devices and procedures."

This guideline is the outcome of an international collaboration among renowned experts in the fields of electrophysiology, cardiology, pediatric electrophysiology and cardiology, as well as biostatistics and epidemiology. The writing committee actively involved a patient partner in the development process to ensure that the recommendations prioritize delivering the best possible patient care aligned with patients' desires, requirements, and preferences. The HRS-led guideline was developed in partnership with and endorsed by APHRS and LAHRS, and in collaboration with and endorsed by the American College of Cardiology, the American Heart Association, Heart Failure Society of America, the International Society for Holter and Noninvasive Electrocardiology, and the Pediatric and Congenital Electrophysiology Society.

The guideline will be jointly published in Heart Rhythm and the Journal of Arrhythmia. Its release will coincide with a session at Heart Rhythm 2023 in New Orleans―a premier event gathering heart rhythm professionals from around the world to advance the field of electrophysiology and improve patient outcomes through the exchange of groundbreaking science, innovative technologies, and life-saving therapies.

Additional Resources

• After May 20, 2023, view the manuscript online in Heart Rhythm
• The document will be presented at Heart Rhythm 2023 during the session "The HRS/APHRS/LAHRS Guideline on Cardiac Physiologic Pacing for the Avoidance and Mitigation of Heart Failure" on May 20, 2023 at 1:30 pm CT
• The consensus statement was developed in accordance with HRS Clinical Document Development Methodology Manual and Policies

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