In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.

Advocate Children's Heart Institute Chicago IL USA

Amrita Institute of Medical Sciences Kochi India

Bambino Gesù Children's Hospital IRCCS Rome Italy

Baylor College of Medicine Houston TX USA

Bristol Royal Hospital for Children Bristol United Kingdom

Children's Heart Center Charles University Prague and Motol University Hospital Prague Czech Republic

Evelina London Children's Hospital and St Thomas' Hospital Guy's and St Thomas' NHS Foundation Trust London United Kingdom

Georg August University Medical Center Göttingen Germany

George Washington University Washington DC USA

Harvard Medical School Boston MA USA

Heart Centre Leipzig University of Leipzig Leipzig Germany

Hospital de Pediatría Juan P Garrahan Hospital El Cruce Hospital Británico de Buenos Aires Instituto Cardiovascular ICBA Buenos Aires Argentina

Inova Children's Hospital Fairfax VA USA

Mayo Clinic Rochester MN USA

New York University Grossman School of Medicine New York NY USA

New York University Langone Health New York NY USA

Nicklaus Children's Hospital Miami FL USA

Oregon Health and Science University Portland OR USA

Shizuoka General Hospital and Mt Fuji Shizuoka Children's Hospital Shizuoka Japan

St Luke's Health System Boise ID USA

Stanford University Palo Alto CA USA

The Hospital for Sick Children Toronto Canada

University of Michigan Ann Arbor MI USA

University of Missouri Kansas City School of Medicine Kansas City MO USA

University of Pennsylvania Perelman School of Medicine Philadelphia PA USA

University of Southern California Keck School of Medicine Los Angeles CA USA

University of Utah Health Sciences Center Salt Lake City UT USA

University of Wisconsin School of Medicine and Public Health Madison WI USA

University Pediatricians Children's Hospital of Michigan Detroit MI USA

Vanderbilt University Medical Center Nashville TN USA

Washington University in St Louis St Louis Missouri USA

Yale University School of Medicine New Haven CT USA

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