2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure

Heart Rhythm. 2023 Sep;20(9):e17-e91. doi: 10.1016/j.hrthm.2023.03.1538. Epub 2023 May 20.


Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.

Keywords: Cardiac resynchronization therapy; Conduction system pacing; Guideline; His bundle pacing; Left bundle branch area pacing.

Publication types

  • Practice Guideline

MeSH terms

  • Bundle of His
  • Cardiac Conduction System Disease
  • Cardiac Resynchronization Therapy* / methods
  • Child
  • Electrocardiography / methods
  • Heart Failure* / therapy
  • Humans
  • Treatment Outcome