Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association.

Cardiac pacing as an adjunct therapy for heart failure began to be the subject of scientific research at the start of the 1990s. The first pacing modality to be examined was dual-chamber pacing with a short atrioventricular (AV) delay, in patients with heart failure but without the classical bradyarrhythmic indications for pacing. The first studies in this area gave promising results. Acute and short-term improvements resulted from the optimization of left ventricular (LV) filling and a reduction in pre-systolic mitral regurgitation. Unfortunately, the initial results were not confirmed by subsequent studies and the early hopes raised by dual-chamber pacing with a short AV delay for heart failure patients were not fulfilled. In contrast, atrio-biventricular pacing for patients with symptomatic heart failure and intra- or interventricular conduction disturbances has proved beneficial. During the last decade, a number of studies have established a theoretical basis for this new therapy and have drawn related conclusions regarding the importance of resynchronization in terms of improving symptoms, morbidity, and mortality in these patients. This document presents the recommendations of the committee concerning indications for CRT based on the most recent studies.