Perspective:

The following are 10 points to remember from this guideline document dealing with cardiac pacing and cardiac resynchronization therapy (CRT):

1. Pacing is indicated for symptomatic sinus node dysfunction, and may be considered in the absence of conclusive evidence if symptoms are likely to be from bradycardia.

2. Pacing is indicated for 3° or type II 2° atrioventricular block (AVB) regardless of symptoms.

3. Pacing should be considered in patients ≥40 years old with recurrent, unpredictable neurocardiogenic syncope and documented symptomatic pauses despite alternative therapies.

4. Pacing is indicated for patients with syncope, bundle branch block (BBB), and a His-ventricular interval ≥70 ms or pathologic AVB during atrial pacing.

5. Pacing is indicated for alternating BBB even if the patient is asymptomatic.

6. CRT is recommended for functional class II, III, or ambulatory-IV heart failure (HF) despite optimal medical therapy in patients with left BBB (LBBB), QRS duration ≥120 ms, and ejection fraction (EF) ≤35%.

7. CRT should be considered for class II, III, or ambulatory-IV HF despite optimal medical therapy in patients with QRS duration ≥150 ms, non-LBBB, and EF ≤35%.

8. CRT may be considered for patients with QRS duration 120-150 ms, non-LBBB, EF ≤35%, and functional class II, III, or ambulatory-IV HF despite optimal medical therapy.

9. In candidates for CRT, an implantable cardioverter-defibrillator with CRT (CRT-D) is recommended when life expectancy is >1 year and HF is stable.

10. In CRT candidates, factors favoring a CRT pacemaker over a CRT-D are class IV HF, severe renal insufficiency/failure, or cachexia.