Thread by @gokselcinier

So after #ESCCongress we have a new guideline on cardiac pacing and resynchronisation.Some important points to highlight
@escardio @TKDsosyal @EHRAPresident @Steph_Achenbach @vaytekin @m_degertekin @ERTUGRULOKUYAN @doctormutlu @DursunAras2 @ErsaTatl @ahmetilker1 @taylanakgun

Lets start with Dx:

Bingo for imagers @uygurbegum_ @gamzebaburguler @drzgezdentok1
Echo is must and CMRI/CT/PET is needed for <60 y

Bingo for geneticists
Genetic testing is desired for < 50 y

Sleep apnea
Not only important for AF but also for bradycardia so check it before PM

When do we need EPS in syncope? @mertilkerh
If there is a high pre-test probability which are;
1) sinus bradycardia
2) bundle branch block
3) suspected tachycardia
4) structural heart disease
If it is (-) >>> ILR is warranted

What if the patient has BBB and syncope?
This figure tells you all!
@ayhankup @kamilgulsen @ismailblbn @baskovski
Also beware of alternating BBB which is a PM indication

And here comes the sweet part
Pacing and the role of Tilt table for reflex syncope @MDTolgaAksu
I don’t know whether this guideline is more accurate but it seems more straightforward
Tilt table is a must for this guide
It is pacing guideline so no recommendation for CNA

Let’s dive into CRT part @TwitKardiyoloji @mertilkerh

Nothing particularly new for those in SR

In case of AF, there are some news for us from #ESCCongress
According to the #APAFCRT study those with permanent AF and symptomatic HF, AVJ abl + CRT is better than drugs. No interaction for LVEF < or > 35%
Full text : bit.ly/3jEkRcl

What if a patient has heart failure and need pacing?
If LVEF <40%, this guideline recommends implanting CRT

A never ending story of CRT-P vs CRT-D
Shared decision making is must but if the patient is old, of non-ischemic etiology and has multiple severe comorbidities then CRT-P would be more reasonable.

And the shining conduction system pacing! #dontdisthehis
No strong recommendation in this guideline but authors admit that they may need to revise their recommendations if more RCT data would emerge

Class IIA for bail-out
Class IIB for AVB+LVEF>40% and anticipated RV pacing >20%

Leadless pacemakers >>> again for bailout scenarios and class IIB for alternative to single lead ventricular pacing

Pacing indications during acute MI
- It is advised to wait for 5-10 days for permanent PM
When to consider earlier implant (at least 5 days)
* failed revasc
* anterior MI
* bifascicular block
* progression of the block

Post-TAVR management @canyucelkarabay
* Wait for 24-48 h
* PM if pre-existing RBBB + new transient high degree AVB, PR prolongation or QRS axis change
* Holter or EPS for those w/ new LBBB (QRS >150) or PR > 240

Congenital AV block >>> nothing new

Perioperative Management:
1) Fever within 24 h and temporary pacing were associated with device infection >> AVOID THEM if possible
2) Single dose of prophylactic antibiotics within 30-60 min >> MUST
3) Use clorhexidine-alcohol

Anticoagulants/Antiplatelets
1) No bridging!!!
2) In case (N)OAC+Antiplatelet >> try discontinue the latter
3) Dual Antiplatelet >>> try to go with ASA alone
4) VKA >>> Continue
5) NOAC >>> ıt is possible to continue at the discretion of the operator

Procedural/Post-procedural considerations
1) Active vs passive lead >>> no RCT yet >>>
active leads > more perforations?
passive leads > lower success, hard to extract
2) Try implanting to midseptum for those w/high risk for perforation
3) Rinse the pocket with normal saline

When patient with CIED needs MRI 👇

These were my highlights! #TSCYoung @ISE_YCommunity @scaganefe @drsedd @MDuyguinan @DrOguzhan1907 @emraherdoganmd @ElifhandeMD @drmuratcap @umityasarsinan1 @AlperKarakus_MD @myilmaztepe @Allan_Bohm @DavidDuncker @rladeiraslopes @DrAfzalSohaib