Pacemaker and cardiac Resynchronization Treatment Comments on the 2021 ESC Guidelines (2022)

Whereas standard pacemaker therapy has been established for decades, the new ESC guidelines on cardiac pacing and cardiac resynchronization emphasize the correlation of symptoms related to documented pauses and a pacing indication especially for patients with syncope. Asymptomatic pauses only justify a pacing indication in individual cases. The value of implantable loop recorders is underlined. In addition, the recent guidelines present only minimal changes in the indications for CRT, including a downgrade for LSB and QRS complex 130-149 ms and for CRT upgrade, as well as an upgrade of CRT in line with the pace-and-ablate concept. Besides, recommendations for pacing after TAVI are presented for the first time. Novel forms of pacing such as leadless pacing and conduction system pacing are now discussed, with limited recommendations for leadless pacing and His pacing or left bundle branch pacing, yet.