Heart Rhythm Society and The American College of Cardiology Foundation Release Expert Consensus Statement on Pacemaker Device and Mode Selection

International consensus writing group provides specific recommendations on mode choices for single- versus dual- chamber devices for adult population

July 30, 2012

Media Contact

Shane Osborne
Heart Rhythm Society
media@hrsonline.org
202-464-3431

WASHINGTON, July 30, 2012 –The Heart Rhythm Society (HRS) and the American College of Cardiology Foundation (ACCF), today released the HRS/ACCF Expert Consensus Statement on Pacemaker Device and Mode Selection.The expert consensus statement was developed in collaboration with the Society of Thoracic Surgeons, endorsed by the American Heart Association, and published online today as part of the August edition of HeartRhythm, the official journal of the Heart Rhythm Society, as well as the Journal of the American College of Cardiology. The statement is the first of its kind to specifically address pacemaker device and mode selection, expanding upon the ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities.

The new statement provides a state-of-the-art review of the field and reports consensus recommendations on pacemaker device and mode selection. It is a guide to facilitate the appropriate use of single vs. dual-chamber devices for patients who already meet guidelines for pacemaker implantation and a clinical decision for pacing has been made. It 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.

Approximately 400,000 devices are implanted each year in the United States, and there are currently more than three million patients with implanted cardiac devices1. 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, showing an unmet need for uniformed recommendations.   

“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 of the statement, Anne M. Gillis, MD, FHRS, 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 optimize patient outcomes.”

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.  The specific recommendations were based on data derived from multiple randomized clinical trials, single randomized trials or non-randomized trials and the consensus opinion of the experts, case studies or standard of care.

Collectively, the consensus experts recommend 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 resynchronization therapy are not addressed in this document as they are currently provided in previously published guidelines.

The complete expert consensus statement is available online at www.heartrhythmjournal.com and published in print in the August edition of HeartRhythm, the official journal of the Heart Rhythm Society. It will also be published in the August 14 issue of the Journal of the American College of Cardiology and is available online at http://content.onlinejacc.org .

1American Heart Association, “Cardiology Patient Page, Pacemaker and Defibrillator Lead Extraction” (Circulation 2011; 123: e378-e380), E. Buch, MD. http://circ.ahajournals.org/content/123/11/e378.full

About the Heart Rhythm Society

The Heart Rhythm Society is the international leader in science, education and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education and optimal health care policies and standards. Incorporated in 1979 and based in Washington, DC, it has a membership of more than 5,900 heart rhythm professionals in more than 70 countries around the world. For more information, visit www.HRSonline.org .

About the HeartRhythm Journal

HeartRhythm provides rapid publication of the most important science developments in the field of arrhythmias and cardiovascular electrophysiology (EP). As the official journal of the Heart Rhythm Society, HeartRhythm publishes both basic and clinical subject matter of scientific excellence devoted to the EP of the heart and blood vessels, as well as therapy. The journal is the only EP publication serving the entire electrophysiology community from basic to clinical academic researchers, private practitioners, technicians, industry and trainees. HeartRhythm has an impact factor of 4.866 (as of 2016) and ranks 23rd out of 114 cardiovascular medicine journals worldwide by the Institute for Scientific Information, remaining the number one specialty journal in cardiology. It is also the official publication of the Cardiac Electrophysiology Society.

About the American College of Cardiology

The American College of Cardiology is the professional home for the entire cardiovascular care team. The mission of the College and its more than 52,000 members is to transform cardiovascular care and to improve heart health. The ACC leads in the formation of health policy, standards and guidelines. The College operates national registries to measure and improve care, offers cardiovascular accreditation to hospitals and institutions, provides professional medical education, disseminates cardiovascular research and bestows credentials upon cardiovascular specialists who meet stringent qualifications. More information about the association is available online at www.acc.org .