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The publication of major studies dealing with the natural history of bradyarrhythmias and tachyarrhythmias and major advances in the technology of pacemakers and implantable cardioverter-defibrillators (ICDs) has mandated this revision of the 1991 ACC/AHA Guidelines for Implantation of Pacemakers and Antiarrhythmia Devices. This executive summary appears in the April 7, 1998 issue of Circulation. The full text of the guidelines, including the ACC/AHA Class I, II, and III recommendations, is published in the April 1998 issue of the Journal of the American College of Cardiology. Reprints of both the executive summary and the full text are available from both organizations. Following extensive review of the medical literature and related documents previously published by the American College of Cardiology, the American Heart Association, and the North American Society for Pacing and Electrophysiology, the writing committee developed recommendations that are evidence based whenever possible. Evidence supporting current recommendations is ranked as level A if the data were derived from multiple randomized clinical trials involving a large number of individuals. Evidence was ranked as level B when data were derived from a limited number of trials involving comparatively small numbers of patients or from well-designed data analysis of nonrandomized studies or observational data registries. Evidence was ranked as level C when consensus of expert opinion was the primary source of recommendation. The committee emphasizes that for certain conditions for which no other therapies are available, the indications for device therapies are based on years of clinical experience as well as expert consensus and are thus well supported, even though the evidence was ranked as level C. These guidelines include expanded sections on selection of pacemakers and ICDs, optimization of technology, cost, and follow-up of implanted devices. The follow-up sections are relatively brief because in many instances the type and frequency of follow-up examinations …