2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy.

Cardiac pacing has been incorporated into so many areas and can be used to treat such a range of clinical conditions, that it has become a pillar of cardiology practice. Technological advances in recent years have led to marked changes in the characteristics and functions of the systems that are used, broadening the horizons for the management of a variety of clinical conditions, while minimizing unwanted effects. However, the paradigm shift goes beyond mere improvements in hardware, software, and lead structure. Compared with previous decades, huge strides have been made in how we assess, follow-up and detect patients’ problems and needs. Indeed, we now talk about not just ‘‘following up’’ patients but also ‘‘monitoring’’ them, which implies a major change in the volume of data, access, responsiveness, and the way we interact with patients. Recent years have also seen the introduction of new technologies, such as leadless pacemakers, which have become highly prominent and, in the future, may become the first choice of treatment. There has also been strong renewed interest in ‘‘physiological’’ methods of cardiac pacing, some of our colleagues being veritable pioneers of these methods. This, and much more, means that the ESC 2021 guidelines on cardiac pacing and cardiac resynchronization therapy include significant changes from their previous version. The most noteworthy aspects are discussed in this editorial.