p.14 抽出テキスト

.................................................................... pacemaker implantations per million people in Azerbaijan, Bosnia and Herzegovina, and Kyrgyzstan, to >1000 implantations per million people in France, Italy, and Sweden.1 These differences may result from under- or overtreatment with pacemaker therapy in some countries, or from variations in sociodemographic characteristics and pathological conditions. There is a continuous growth in the use of pacemakers due to the increasing life expectancy and ageing of populations.28 The estimated number of patients globally undergoing pacemaker implantation has increased steadily up to an annual implant rate of 1 million devices.2 Degeneration of the cardiac conduction system and changes in intercellular conduction can be manifestations of cardiac pathology or non-cardiac disease, and are most prevalent in older patients. Therefore, most bradycardias requiring cardiac pacing are observed in the elderly, with >80% of pacemakers being implanted in patients above the age of 65 years.

3.2 Natural history

High-degree atrioventricular block (AVB) and sinus node dysfunction (SND) are the most common indications for permanent pacemaker therapy. Conservatively treated (i.e. non-paced) patients with highdegree AVB have notably poorer survival compared with pacemaker-treated patients.912 In contrast, SND follows an unpredictable course, and there is no evidence to show that pacemaker therapy results in improved prognosis.1315

Improving life expectancy is not, however, the only objective of pacemaker therapy. Quality of life is an essential metric for measuring a patient’s clinical status and outcome, and provides a holistic picture of clinical treatment effectiveness.16 Studies have been unanimous in finding improved quality of life in patients receiving pacing therapy.1722

3.3 Pathophysiology and classification of

bradyarrhythmias considered for permanent cardiac pacing therapy Definitions of various conduction disturbances are presented in Supplementary Table 1. Sinus bradycardia can be considered physiological in response to specific situations, such as in well-conditioned athletes, young individuals, and during sleep. Pathological bradyarrhythmias are dependent on their underlying cause and can be broadly categorized into intrinsic and extrinsic aetiologies. Advanced age and age-related degenerative changes are important intrinsic causes of modifications in electrical impulse initiation and propagation of the conduction

Preimplant evaluation Minimizing complication

risk Pacing for bradycardia Pacing in patients with rare diseases Pacing in patients after cardiac surgery High risk reflex syncope

HBP in bradycardia

or CRT

Pacing in TAVI

patients CRT indications

Leadless pacing

New in these guidelines

Figure 1 The 2021 ESC Guidelines on cardiac pacing and CRT present new and updated recommendations for these treatments in relevant patient populations. Downloaded from academic.oup.com/eurheartj/article/42/35/3427/6358547 by guest on 07 October 2026