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Press release

HRS, APHRS, and LAHRS release cardiac physiological pacing guideline

New Orleans | May 20, 2023

New guidance published in Heart Rhythm covers recommendations on pacing device indications, pre/during/post implant evaluations, and optimization of pacing response in adults and children

Today, the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Latin American Heart Rhythm Society (LAHRS) released a new clinical practice guideline on cardiac physiologic pacing (CPP) strategies to restore ventricular synchrony and improve cardiac performance. The 2023 HRS/APHRS/LAHRS Guideline on Cardiac Physiologic Pacing for the Avoidance and Mitigation of Heart Failureopens in new tab/window is intended to provide guidance to clinical cardiac electrophysiologists, cardiologists, and other clinicians on the use of CPP, which includes cardiac resynchronization therapy and conduction system pacing, in patients with indications for pacemakers or heart failure. The guideline appears in Heart Rhythmopens in new tab/window, published by Elsevier.

Heart failure is a leading cause of morbidity and mortality and is responsible for significant healthcare costs. Cardiac resynchronization therapy has been shown to reduce heart failure symptoms and improve heart function and survival rates in select patients.

Over the past few years, new data have emerged on the optimization of pacing techniques and new pacing-related therapies to improve survival in patients with heart failure. With recent advances in technology, conduction system pacing has emerged as a potential alternative to traditional pacing and cardiac resynchronization therapy.

“The field of physiologic pacing has undergone significant expansion and these technological advancements gave rise to questions regarding patient selection, indications, and follow-up procedures,” said Mina K. Chung, MD, FHRS, from the Cleveland Clinic and Chair of the guideline. “We hope that this guideline answers those questions and provides evidence-based practical guidance on pacing practices in patients with heart failure.”

Throughout the guideline, the authors emphasize the importance of shared decision-making between providers and patients when considering treatment with a CPP device. These discussions should account for the patient's values, preferences, and care goals, while considering the potential advantages and risks associated with the pacing therapy. In addition, the authors acknowledge there remain critical gaps in our current understanding within the field and highlight novel directions for future research.

“More randomized trials and long-term data are required, specifically around clinical outcomes from conduction system pacing,” said Kristen K. Patton, MD, FHRS, from the University of Washington and Vice-Chair of the guideline. “We’ve identified several areas for future study, and we hope this document will serve as a valuable guide for researchers and industry partners involved in the advancement of these devices and procedures.”

This guideline is the outcome of an international collaboration among renowned experts in the fields of electrophysiology, cardiology, pediatric electrophysiology and cardiology, as well as biostatistics and epidemiology. The writing committee actively involved a patient partner in the development process to ensure that the recommendations prioritize delivering the best possible patient care aligned with patients' desires, requirements, and preferences. The HRS-led guideline was developed in partnership with and endorsed by APHRS and LAHRS, and in collaboration with and endorsed by the American College of Cardiology, the American Heart Association, the Heart Failure Society of America, the International Society for Holter and Noninvasive Electrocardiology, and the Pediatric and Congenital Electrophysiology Society.

The guideline is jointly published in Heart Rhythm and the Journal of Arrhythmia. Its release will coincide with a session at Heart Rhythm 2023 in New Orleans―a premier event gathering heart rhythm professionals from around the world to advance the field of electrophysiology and improve patient outcomes through the exchange of groundbreaking science, innovative technologies, and life-saving therapies.


Notes for editors

The guideline is 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure, by Mina K. Chung, MD, FHRS (Chair), Kristen K. Patton, MD, FHRS (HRS Vice-Chair) et al ( in new tab/window). The article appears online on May 20, 2023 in Heart Rhythmpublished by Elsevier.

The article is openly available at in new tab/window.

Additional resources

The document is being presented at Heart Rhythm 2023 opens in new tab/windowduring the session “The HRS/APHRS/LAHRS Guideline on Cardiac Physiologic Pacing for the Avoidance and Mitigation of Heart Failure” on May 20, 2023, at 1:30 PM CT.

The consensus statement was developed in accordance with HRS Clinical Document Development Methodology Manual and Policiesopens in new tab/window.

Full text of the guideline is also available to credentialed journalists upon request; contact Jane Grochowski at +1 406 542 8397; [email protected]opens in new tab/window or Kris Murphy, Heart Rhythm Society, at [email protected]opens in new tab/window.

About Heart Rhythm 

Heart Rhythmopens in new tab/window, the official Journal of the Heart Rhythm Societyopens in new tab/window, the Cardiac Electrophysiology Societyopens in new tab/window, and the Pediatric & Congenital Electrophysiology Societyopens in new tab/window, is a unique journal for fundamental discovery and clinical applicability. It integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community. www.heartrhythmjournal.comopens in new tab/window

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 healthcare policies and standards. Incorporated in 1979 and based in Washington, D.C., it has a membership of more than 8,000 heart rhythm professionals from 94 countries. For more information, visit www.HRSonline.orgopens in new tab/window.

About Heart Rhythm 2023

The Heart Rhythm Society's annual Heart Rhythm meeting convenes 7,000+ of the world’s finest clinicians, scientists, researchers, and innovators in the field of cardiac pacing and electrophysiology. More than 1,500 international experts in the field will serve as faculty and presenters for the 200+ educational sessions, forums, symposia, and ceremonies, while 120+ exhibitors will showcase innovative products and services. For more information, visit www.HeartRhythm.comopens in new tab/window.

About the Asia Pacific Heart Rhythm Society

The Asia Pacific Heart Rhythm Society (APHRS) is the international organization specializing in science and education for cardiac arrhythmia professionals. For members, the society regularly offers various educational programs at the state-of-the-art laboratories with excellent lectures. For more information, visit www.aphrs.orgopens in new tab/window.

About the Latin American Heart Rhythm Society

The Latin American Heart Rhythm Society (LAHRS) was founded in 2017 with the aim of continuing the mission started by Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLAECE) more than twenty years ago, promoting the improvement of the quality of life and reducing mortality related to cardiac arrhythmias in the Latin American population. For more information, visit www.lahrs.orgopens in new tab/window.

About Elsevier

As a global leader in scientific information and analytics, Elsevier helps researchers and healthcare professionals advance science and improve health outcomes for the benefit of society. We do this by facilitating insights and critical decision-making with innovative solutions based on trusted, evidence-based content and advanced AI-enabled digital technologies.

We have supported the work of our research and healthcare communities for more than 140 years. Our 9,500 employees around the world, including 2,500 technologists, are dedicated to supporting researchers, librarians, academic leaders, funders, governments, R&D-intensive companies, doctors, nurses, future healthcare professionals and educators in their critical work. Our 2,900 scientific journals and iconic reference books include the foremost titles in their fields, including Cell Press, The Lancet and Gray’s Anatomy.

Together with the Elsevier Foundationopens in new tab/window, we work in partnership with the communities we serve to advance inclusion and diversity in science, research and healthcare in developing countries and around the world.

Elsevier is part of RELXopens in new tab/window, a global provider of information-based analytics and decision tools for professional and business customers. For more information on our work, digital solutions and content, visit



Kris Murphy

Heart Rhythm Society

E-mail Kris Murphy


Jane Grochowski



+1 406 542 8397

E-mail Jane Grochowski