Skip to main content
SpringerLink
Log in

ESC-Leitlinien 2021 zur Schrittmacher- und Resynchronisationstherapie

Was gibt es Neues?

ESC guidelines 2021 on cardiac pacing and cardiac resynchronization therapy

What’s new?

  • Schwerpunkt
  • Published:
Herz Aims and scope Submit manuscript

Zusammenfassung

Die neuen Leitlinien der European Society of Cardiology (ESC) zur Herzschrittmacher- und Resynchronisationstherapie wurden im September zeitgleich mit den neuen Herzinsuffizienzleitlinien am ESC-Kongress vorgestellt. Das neue Dokument beinhaltet ausführliche Abschnitte von der Patientenevaluation und klinischen Beurteilung über die Implantation und die Minimierung von Komplikationen bis zur Nachsorge. Aktualisiert und ergänzt wurden die Leitlinien dabei insbesondere um das Vorgehen bei Reflexsynkopen, die Indikation nach Transkatheteraortenklappenimplantation (TAVI) sowie das perioperative Management. Die Indikationen zur kardialen Resynchronisationstherapie wurden mit den Herzinsuffizienzleitlinien abgeglichen. Neue physiologische Stimulationsformen sowie der kabellose Schrittmacher wurden in die Leitlinien aufgenommen.

Abstract

The new European Society of Cardiology (ESC) guidelines on cardiac pacing and cardiac resynchronization therapy were presented together with the new ESC heart failure guidelines at the ESC congress in September. The new document includes detailed sections on patient evaluation and clinical assessment, implantation, minimizing complications and patient follow-up. The guidelines have been updated and expanded particularly on the approach to reflex syncope, the indications after transcatheter aortic valve implantation (TAVI) and the perioperative management. The indications for cardiac resynchronization therapy (CRT) are now in line with the simultaneously published ESC heart failure guidelines. New physiological forms of stimulation and leadless pacing are now included in the guidelines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Brignole M, Auricchio A, Baron-Esquivias G et al (2013) 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European society of cardiology (ESC). Developed in collaboration with the European heart rhythm association (EHRA). Eur Heart J 34:2281–2329

    PubMed  Google Scholar 

  2. Glikson M, Nielsen JC, Kronborg MB et al (2021) 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: developed by the task force on cardiac pacing and cardiac resynchronization therapy of the European society of cardiology (ESC) with the special contribution of the European heart rhythm association (EHRA). Eur Heart J 42:3427–3520

    PubMed  Google Scholar 

  3. Shen W‑K, Sheldon RS, Benditt DG et al (2017) 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart rhythm society. Circulation 136:e60–e122

    PubMed  Google Scholar 

  4. Jackson LR 2nd, Rathakrishnan B, Campbell K et al (2017) Sinus node dysfunction and atrial fibrillation: a reversible phenomenon? Pacing Clin Electrophysiol 40:442–450

    PubMed  Google Scholar 

  5. Chen YW, Bai R, Lin T et al (2014) Pacing or ablation: which is better for paroxysmal atrial fibrillation-related tachycardia-bradycardia syndrome? Pacing Clin Electrophysiol 37:403–411

    PubMed  Google Scholar 

  6. Inada K, Yamane T, Tokutake K et al (2014) The role of successful catheter ablation in patients with paroxysmal atrial fibrillation and prolonged sinus pauses: outcome during a 5-year follow-up. Europace 16:208–213

    PubMed  Google Scholar 

  7. Baron-Esquivias G, Morillo CA, Moya-Mitjans A et al (2017) Dual-chamber pacing with closed loop stimulation in recurrent reflex vasovagal syncope: the SPAIN study. J Am Coll Cardiol 70:1720–1728

    PubMed  Google Scholar 

  8. Brignole M, Russo V, Arabia F et al (2021) Cardiac pacing in severe recurrent reflex syncope and tilt-induced asystole. Eur Heart J 42:508–516

    PubMed  Google Scholar 

  9. Mcdonagh TA, Metra M, Adamo M et al (2021) 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European society of cardiology (ESC) with the special contribution of the heart failure association (HFA) of the ESC. Eur Heart J 42:3599–3726

    CAS  PubMed  Google Scholar 

  10. Zinman B, Wanner C, Lachin JM et al (2015) Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 373:2117–2128

    CAS  PubMed  Google Scholar 

  11. Mcmurray JJV, Solomon SD, Inzucchi SE et al (2019) Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 381:1995–2008

    CAS  PubMed  Google Scholar 

  12. Mcmurray JJV, Packer M, Desai AS et al (2014) Angiotensin–neprilysin inhibition versus enalapril in heart failure. N Engl J Med 371:993–1004

    PubMed  Google Scholar 

  13. Kaye GC, Linker NJ, Marwick TH et al (2015) Effect of right ventricular pacing lead site on left ventricular function in patients with high-grade atrioventricular block: results of the protect-pace study. Eur Heart J 36:856–862

    PubMed  Google Scholar 

  14. Leclercq C, Sadoul N, Mont L et al (2016) Comparison of right ventricular septal pacing and right ventricular apical pacing in patients receiving cardiac resynchronization therapy defibrillators: the SEPTAL CRT study. Eur Heart J 37:473–483

    PubMed  Google Scholar 

  15. Deshmukh P, Casavant DA, Romanyshyn M et al (2000) Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation. Circulation 101:869–877

    CAS  PubMed  Google Scholar 

  16. Vijayaraman P, Dandamudi G, Zanon F et al (2018) Permanent his bundle pacing: recommendations from a multicenter his bundle pacing collaborative working group for standardization of definitions, implant measurements, and follow-up. Heart Rhythm 15:460–468

    PubMed  Google Scholar 

  17. Ali N, Keene D, Arnold A et al (2018) His bundle pacing: a new frontier in the treatment of heart failure. Arrhythm Electrophysiol Rev 7:103–110

    PubMed  PubMed Central  Google Scholar 

  18. El-Chami MF, Al-Samadi F, Clementy N et al (2018) Updated performance of the micra transcatheter pacemaker in the real-world setting: a comparison to the investigational study and a transvenous historical control. Heart Rhythm 15:1800–1807

    PubMed  Google Scholar 

  19. Brodell GK, Cosgrove D, Schiavone W et al (1991) Cardiac rhythm and conduction disturbances in patients undergoing mitral valve surgery. Cleve Clin J Med 58:397–399

    CAS  PubMed  Google Scholar 

  20. Chung MK (2000) Cardiac surgery: postoperative arrhythmias. Crit Care Med 28:N136–144

    CAS  PubMed  Google Scholar 

  21. Jaeger FJ, Trohman RG, Brener S et al (1994) Permanent pacing following repeat cardiac valve surgery. Am J Cardiol 74:505–507

    CAS  PubMed  Google Scholar 

  22. Leon MB, Smith CR, Mack M et al (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363:1597–1607

    CAS  PubMed  Google Scholar 

  23. Smith CR, Leon MB, Mack MJ et al (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364:2187–2198

    CAS  PubMed  Google Scholar 

  24. Leon MB, Smith CR, Mack MJ et al (2016) Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 374:1609–1620

    CAS  PubMed  Google Scholar 

  25. Gilard M, Eltchaninoff H, Iung B et al (2012) Registry of transcatheter aortic-valve implantation in high-risk patients. N Engl J Med 366:1705–1715

    CAS  PubMed  Google Scholar 

  26. Mack MJ, Leon MB, Thourani VH et al (2019) Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med 380:1695–1705

    PubMed  Google Scholar 

  27. Thomas M, Schymik G, Walther T et al (2010) Thirty-day results of the SAPIEN aortic bioprosthesis European outcome (SOURCE) registry: a European registry of transcatheter aortic valve implantation using the edwards SAPIEN valve. Circulation 122:62–69

    PubMed  Google Scholar 

  28. Lilly SM, Deshmukh AJ, Epstein AE et al (2020) 2020 ACC expert consensus decision pathway on management of conduction disturbances in patients undergoing transcatheter aortic valve replacement: a report of the American college of cardiology solution set oversight committee. J Am Coll Cardiol 76:2391–2411

    PubMed  Google Scholar 

  29. Rogers T, Devraj M, Thomaides A et al (2018) Utility of invasive electrophysiology studies in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation. Am J Cardiol 121:1351–1357

    PubMed  Google Scholar 

  30. Tovia-Brodie O, Ben-Haim Y, Joffe E et al (2017) The value of electrophysiologic study in decision-making regarding the need for pacemaker implantation after TAVI. J Interv Card Electrophysiol 48:121–130

    PubMed  Google Scholar 

  31. Burri H, Starck C, Auricchio A et al (2021) EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the heart rhythm society (HRS), the asia pacific heart rhythm society (APHRS), and the Latin-American heart rhythm society (LAHRS). Europace 23:983–1008

    PubMed  Google Scholar 

  32. Udo EO, Zuithoff NP, van Hemel NM et al (2012) Incidence and predictors of short- and long-term complications in pacemaker therapy: the FOLLOWPACE study. Heart Rhythm 9:728–735

    PubMed  Google Scholar 

  33. Koneru JN, Jones PW, Hammill EF et al (2018) Risk factors and temporal trends of complications associated with transvenous implantable cardiac defibrillator leads. J Am Heart Assoc 7(10):e7691. https://doi.org/10.1161/JAHA.117.007691

    Article  PubMed  PubMed Central  Google Scholar 

  34. Ellenbogen KA, Hellkamp AS, Wilkoff BL et al (2003) Complications arising after implantation of DDD pacemakers: the MOST experience. Am J Cardiol 92:740–741

    PubMed  Google Scholar 

  35. Poole JE, Gleva MJ, Mela T et al (2010) Complication rates associated with pacemaker or implantable cardioverter-defibrillator generator replacements and upgrade procedures: results from the REPLACE registry. Circulation 122:1553–1561

    PubMed  Google Scholar 

  36. Darouiche RO, Wall MJ Jr., Itani KM et al (2010) Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 362:18–26

    CAS  PubMed  Google Scholar 

  37. Mimoz O, Lucet JC, Kerforne T et al (2015) Skin antisepsis with chlorhexidine-alcohol versus povidone iodine-alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): an open-label, multicentre, randomised, controlled, two-by-two factorial trial. Lancet 386:2069–2077

    CAS  PubMed  Google Scholar 

  38. Tarakji KG, Mittal S, Kennergren C et al (2019) Antibacterial envelope to prevent cardiac implantable device infection. N Engl J Med 380:1895–1905

    CAS  PubMed  Google Scholar 

  39. Essebag V, Verma A, Healey JS et al (2016) Clinically significant pocket hematoma increases long-term risk of device infection: BRUISE CONTROL INFECTION study. J Am Coll Cardiol 67:1300–1308

    PubMed  Google Scholar 

  40. Higgins JV, Gard JJ, Sheldon SH et al (2014) Safety and outcomes of magnetic resonance imaging in patients with abandoned pacemaker and defibrillator leads. Pacing Clin Electrophysiol 37:1284–1290

    PubMed  Google Scholar 

  41. Horwood L, Attili A, Luba F et al (2017) Magnetic resonance imaging in patients with cardiac implanted electronic devices: focus on contraindications to magnetic resonance imaging protocols. Europace 19:812–817

    PubMed  Google Scholar 

  42. Padmanabhan D, Kella DK, Mehta R et al (2018) Safety of magnetic resonance imaging in patients with legacy pacemakers and defibrillators and abandoned leads. Heart Rhythm 15:228–233

    PubMed  Google Scholar 

  43. Vuorinen AM, Pakarinen S, Jaakkola I et al (2019) Clinical experience of magnetic resonance imaging in patients with cardiac pacing devices: unrestricted patient population. Acta Radiol 60:1414–1421

    PubMed  Google Scholar 

  44. Zecchin M, Severgnini M, Fiorentino A et al (2018) Management of patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy: A consensus document from Associazione Italiana Aritmologia e Cardiostimolazione (AIAC), Associazione Italiana Radioterapia Oncologica (AIRO), Associazione Italiana Fisica Medica (AIFM). Int J Cardiol 255:175–183

    PubMed  Google Scholar 

  45. Hurkmans CW, Knegjens JL, Oei BS et al (2012) Management of radiation oncology patients with a pacemaker or ICD: a new comprehensive practical guideline in The Netherlands. Dutch Society of Radiotherapy and Oncology (NVRO). Radiat Oncol 7:198

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Universitäres Herzzentrum Lübeck, Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin), Klinik für Rhythmologie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    Julia Vogler, Ahmad Keelani, Anna Traub & Roland Richard Tilz

  2. Partner Site Hamburg/Kiel/Lübeck, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Lübeck, Deutschland

    Roland Richard Tilz

Authors
  1. Julia Vogler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmad Keelani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anna Traub
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roland Richard Tilz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roland Richard Tilz.

Ethics declarations

Interessenkonflikt

J. Vogler, A. Keelani, A. Traub und R.R. Tilz geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vogler, J., Keelani, A., Traub, A. et al. ESC-Leitlinien 2021 zur Schrittmacher- und Resynchronisationstherapie. Herz 47, 31–40 (2022). https://doi.org/10.1007/s00059-021-05089-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-021-05089-0

Schlüsselwörter

Keywords

Search

Navigation