News from the Heart Rhythm Society| Volume 9, ISSUE 8, P1344-1365, August 2012

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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
      The most recent American College of Cardiology Foundation/American Heart Association/Heart Rhythm Society (ACCF/AHA/HRS) guidelines related to pacemaker implantation were published as part of a larger document related to device-based therapy.
      • Epstein A.E.
      • et al.
      ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices).
      While this document provides some comments on pacemaker mode selection and algorithms to guide selection, it does not provide specific recommendations regarding choices for single- or dual-chamber devices. Over the past 15 years multiple randomized trials have compared a number of cardiovascular outcomes among patients randomized to atrial or dual-chamber pacing vs those randomized to ventricular pacing. The purpose of this 2012 consensus Statement is to provide a state-of-the-art review of the field and to report the recommendations of a consensus writing group, convened by HRS and ACCF, on pacemaker device and mode selection. This document focuses on pacemaker device and mode selection in the adult patient; therefore, many of the recommendations may not be applicable to unique situations encountered in the pediatric population. These recommendations summarize the opinion of the consensus writing group, based on an extensive literature review as well as their own experience.



      ACCF (American College of Cardiology Foundation), AF (atrial fibrillation), AHA (American Heart Association), AV (atrioventricular), CI (confidence interval), HR (hazard ratio), HRS (Heart Rhythm Society), ICD (implantable cardioverter defibrillator), QALY (quality-adjusted life year), SND (sinus node dysfunction), VT (ventricular tachycardia)
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