Cardiac implantable electronic device upgrades and downgrades: a <i>Clinical Consensus Statement</i> of the European Heart Rhythm Association (EHRA) of the ESC, the Asia Pacific Heart Rhythm Association (APHRS), Canadian Heart Rhythm Society (CHRS),

Cardiac implantable electronic device upgrade and downgrade procedures are increasingly being performed. Whilst the most appropriate guideline-recommended device may have been followed during a patient's initial procedure, the requirements of patients can change over time. This could be due to worsening of cardiac function due to detrimental effects of pacing itself or the diagnosis, development, or progression of another cardiac comorbidity. Device downgrades are also performed when a patient's clinical state changes and are often considered in patients with increased frailty and comorbidity. This clinical consensus statement aims to provide a framework for screening patients for device upgrade, pre-procedural planning considerations, available procedural strategies, namely a summary of techniques and approaches for vascular access, including ipsilateral and contralateral options, and a framework for when extraction to gain access may be appropriate. The document also provides advice on how to frame an ethical discussion with patients and carers on available options.

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Publication Details

Journal
EP Europace
Published
2025-12-01
DOI
https://doi.org/10.1093/europace/euaf252
Primary Topic
Cardiac pacing and defibrillation studies
Type
article
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article

Cardiac implantable electronic device upgrades and downgrades: a Clinical Consensus Statement of the European Heart Rhythm Association (EHRA) of the ESC, the Asia Pacific Heart Rhythm Association (APHRS), Canadian Heart Rhythm Society (CHRS),

Inga Drossart, Chu‐Pak Lau, Lina Marcantoni, Margarida Pujol‐López et al.
EP Europace
Cardiac pacing and defibrillation studies
article

Cardiac implantable electronic device upgrades and downgrades: a Clinical Consensus Statement of the European Heart Rhythm Association (EHRA) of the ESC, the Asia Pacific Heart Rhythm Association (APHRS), Canadian Heart Rhythm Society (CHRS),

Inga Drossart, Chu‐Pak Lau, Lina Marcantoni, Margarida Pujol‐López, Jean‐Claude Deharo, James E. Ip, Jens Brock Johansen, Archana Rao, Nandita Kaza, Julia Vogler, José Marı́a Tolosana, Haran Burri, Jaimie Manlucu, Daniel Keene, Carsten W. Israel, Christoph Starck, Annamária Kosztin, Carlos A. Chávez-Gutiérrez, Lieselot van Erven, Shuli Levy, Jan M. Nielsen
article en

Abstract

Cardiac implantable electronic device upgrade and downgrade procedures are increasingly being performed. Whilst the most appropriate guideline-recommended device may have been followed during a patient's initial procedure, the requirements of patients can change over time. This could be due to worsening of cardiac function due to detrimental effects of pacing itself or the diagnosis, development, or progression of another cardiac comorbidity. Device downgrades are also performed when a patient's clinical state changes and are often considered in patients with increased frailty and comorbidity. This clinical consensus statement aims to provide a framework for screening patients for device upgrade, pre-procedural planning considerations, available procedural strategies, namely a summary of techniques and approaches for vascular access, including ipsilateral and contralateral options, and a framework for when extraction to gain access may be appropriate. The document also provides advice on how to frame an ethical discussion with patients and carers on available options.

EP EuropaceVol. 27(12)
Semmelweis University (HU), Western University (CA), NewYork–Presbyterian Hospital (US), University of Liverpool (GB), Imperial College Healthcare NHS Trust (GB), Royal Free London NHS Foundation Trust (GB), Aarhus University (DK), Cornell University (US), Leiden University Medical Center (NL), Queen Mary Hospital (CN), London Health Sciences Centre (CA), New York Hospital Queens (US), Odense University Hospital (DK), Aarhus University Hospital (DK), European Society of Cardiology (FR), Humboldt-Universität zu Berlin (DE), Liverpool Heart and Chest Hospital (GB), Universidad América Latina (MX), Secretaría de Salud de Jalisco (MX), Centro de Investigación en Red en Enfermedades Cardiovasculares (ES), Presbyterian Hospital (US), Lung Institute (US), University Hospital of Geneva (CH), University Hospital Schleswig-Holstein (DE), Centro de Investigación Biomédica en Red (ES), Asklepios Klinik St. Georg (DE), German Centre for Cardiovascular Research (DE), Ospedale Santa Maria della Misericordia di Rovigo (IT), Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES), Hôpital de la Timone (FR), Weill Cornell Medicine (US), Imperial College London (GB), Charité - Universitätsmedizin Berlin (DE), University of Hong Kong (HK), Bethel University (US), University of Lübeck (DE)
Openalex Percentile: Top 43%
Cardiac pacing and defibrillation studies
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