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


Mina K. Chung, Cleveland Clinic, Cleveland, Ohio.
Kristen K. Patton, University of Washington, Seattle, Washington.
Chu-Pak Lau, University of Hong Kong, Hong Kong, China.
Alexander R. Dal Forno, Hospital SOS Cárdio, Florianópolis, Brazil.
Sana M. Al-Khatib, Duke University Medical Center, Durham, North Carolina.
Vanita Arora, Indraprastha Apollo Hospital, New Delhi, India.
Ulrika Maria Birgersdotter-Green, University of California San Diego Health, La Jolla, California.
Yong-Mei Cha, Mayo Clinic, Rochester, Minnesota.
Eugene H. Chung, University of Michigan Medical School, Ann Arbor, Michigan.
Edmond M. Cronin, Temple University, Philadelphia, Pennsylvania.
Anne B. Curtis, University at Buffalo, Buffalo, New York.
Iwona Cygankiewicz, Medical University of Łódź, Łódź, Poland.
Gopi Dandamudi, Virginia Mason Franciscan Health, Tacoma, Washington.
Anne M. Dubin, Stanford University, Pediatric Cardiology, Palo Alto, California.
Douglas P. Ensch, Cleveland Clinic, Cleveland, Ohio.
Taya V. Glotzer, Hackensack Meridian School of Medicine, Hackensack, New Jersey.
Michael R. Gold, Medical University of South Carolina, Charleston, South Carolina.
Zachary D. Goldberger, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Rakesh Gopinathannair, Kansas City Heart Rhythm Institute, Overland Park, Kansas.
Eiran Z. Gorodeski, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio.
Alejandra Gutierrez, University of Minnesota, Minneapolis, Minnesota.
Juan C. Guzman, McMaster University, Hamilton, Ontario, Canada.
Weijian Huang, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Peter B. Imrey, Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University, Cleveland, Ohio.
Julia H. Indik, University of Arizona, Sarver Heart Center, Tucson, Arizona.
Saima Karim, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
Peter P. Karpawich, The Children's Hospital of Michigan, Central Michigan University, Detroit, Michigan.
Yaariv Khaykin, Southlake Regional Health Center, Newmarket, Ontario, Canada.
Erich L. Kiehl, Sentara, Norfolk, Virginia.
Jordana Kron, Virginia Commonwealth University, Richmond, Virginia.
Valentina Kutyifa, University of Rochester Medical Center, Rochester, New York.
Mark S. Link, University of Texas Southwestern Medical Center, Dallas, Texas.

Document Type

Journal Article

Publication Date



Heart rhythm








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


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.