Societies' guide focuses on pacemaker device, mode selection

The Heart Rhythm Society (HRS) and the American College of Cardiology Foundation (ACCF) have published an expert consensus statement to address pacemaker device and mode selection. The statement is designed to help guide physicians on the use of single versus dual-chamber pacemaker devices for patients who already meet guidelines for pacemaker implantation when a clinical decision for pacing has been made.

The specific recommendations were based on data derived from multiple randomized clinical trials, single randomized trials, non-randomized trials and case studies. The writing group, which consisted of 11 cardiac electrophysiologists and surgeons from the U.S., Canada and Europe, also provided expert opinions that informed the recommendations. The document expands on the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities.

“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 optimize patient outcomes,” said co-lead author Anne M. Gillis, MD, president of HRS, in a release.

The document 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.

The writing group also reviewed outcomes of pacing mode selection for patients with sinus node dysfunction (SND), atrioventricular (AV) conduction block and other less common indications for pacing. Among the recommendations are:

• 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.

• Dual chamber pacing or single chamber atrial pacing should not be used in patients in permanent or longstanding persistent AF. 

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

The complete expert consensus statement is available online and will be published in both the August issue of HeartRhythm and the Aug. 14 issue of the Journal of the American College of Cardiology.