ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2025
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), Heart Rhythm Society (HRS), and the Latin American Heart Rhythm Society (LAHRS).
Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Response to 'Upgrade procedures of pacemakers or implantable cardioverter-defibrillators require creative clinical decision making and careful planning that begins at the first implantation'.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- Upgrade procedures of pacemakers or implantable cardioverter-defibrillators require creative clinical decision making and careful planning that begins at the first implantation.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- Cardiac implantable electronic devices in heart failure: needs, challenges, and real-world implementation.Heart failure reviews · 2026Review
- The 'CIED Team' Approach to Device-Related Complications.JACC. Case reports · 2026Article
- Removal of tine-based leadless pacemakers: insights from a large multicentre experience.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- An Individualized Right-to-Left Tunneling "Bail-Out" for Complex ICD Upgrade in a Pacemaker-Dependent Patient: A Case Report and Literature Review.Journal of personalized medicine · 2026Review
- Cardiac resynchronization therapy in very old patients with pacemakers: a cardiogeriatric, physiology-based approach.Aging clinical and experimental research · 2026Review
- Adverse outcomes due to atrioventricular synchrony loss induced by temporary VVI pacing in patients with pre-existing DDD stimulation: insights from a device recall scenario.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Observational
- Controversy: in heart failure patients with a reduced ejection fraction and left bundle branch block, conduction system pacing can be a valid alternative to biventricular pacing-pro and contra.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Review
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Authors and funding
21 authors.
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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.
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