2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients: Executive summary

Writing Committee Members, Document Reviewers

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Guidelines for the implantation of cardiac implantable electronic devices (CIEDs) have evolved since publication of the initial ACC/AHA pacemaker guidelines in 1984 [1]. CIEDs have evolved to include novel forms of cardiac pacing, the development of implantable cardioverter defibrillators (ICDs) and the introduction of devices for long term monitoring of heart rhythm and other physiologic parameters. In view of the increasing complexity of both devices and patients, practice guidelines, by necessity, have become increasingly specific. In 2018, the ACC/AHA/HRS published Guidelines on the Evaluation and Management of Patients with Bradycardia and Cardiac Conduction Delay [2], which were specific recommendations for patients >18 years of age. This age-specific threshold was established in view of the differing indications for CIEDs in young patients as well as size-specific technology factors. Therefore, the following document was developed to update and further delineate indications for the use and management of CIEDs in pediatric patients, defined as ≤21 years of age, with recognition that there is often overlap in the care of patents between 18 and 21 years of age. This document is an abbreviated expert consensus statement (ECS) intended to focus primarily on the indications for CIEDs in the setting of specific disease/diagnostic categories. This document will also provide guidance regarding the management of lead systems and follow-up evaluation for pediatric patients with CIEDs. The recommendations are presented in an abbreviated modular format, with each section including the complete table of recommendations along with a brief synopsis of supportive text and select references to provide some context for the recommendations. This document is not intended to provide an exhaustive discussion of the basis for each of the recommendations, which are further addressed in the comprehensive PACES-CIED document [3], with further data easily accessible in electronic searches or textbooks.

Original languageEnglish
Pages (from-to)349-366
Number of pages18
JournalIndian Pacing and Electrophysiology Journal
Issue number6
StatePublished - Nov 1 2021


  • Ambulatory ECG monitoring
  • Antiarrhythmic drug therapy
  • Antitachycardia pacing
  • Arrhythmogenic cardiomyopathy
  • Asystole
  • Atrioventricular block
  • Bradycardia
  • Brugada syndrome
  • Cardiac channelopathies
  • Cardiac transplantation
  • Cardiomyopathy
  • Cardiovascular implantable electronic devices
  • Catecholaminergic polymorphic ventricular tachycardia
  • Children
  • Congenital heart disease
  • Coronary artery compression
  • ECG
  • Echocardiography
  • Endocardial lead
  • Epicardial lead
  • Expert consensus statement
  • Genetic arrhythmias
  • Heart block
  • Heart failure
  • Hypertrophic cardiomyopathy
  • Implantable cardioverter defibrillator
  • Insertable cardiac monitor
  • Lead extraction
  • Lead removal
  • Long QT syndrome
  • Low- and middle-income countries
  • MR imaging
  • Neuromuscular disease
  • Pacemaker
  • Pediatrics
  • Postoperative
  • Remote monitoring
  • Shared decision-making
  • Sick sinus syndrome
  • Sports and physical activity
  • Sudden cardiac arrest
  • Sudden cardiac death
  • Syncope
  • Transvenous
  • Ventricular fibrillation
  • Ventricular tachycardia


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