Positive Childhood Experiences are Associated With Alcohol Use in Adolescent and Emerging Adult Females by Adverse Childhood Experiences Dimension.

PURPOSE: Experiencing multiple adverse childhood experiences (ACEs) is associated with alcohol use in female adolescents and emerging adults. Protective and compensatory experiences (PACEs) have been theorized to off-set the health and behavioral consequences from the accumulation of ACEs throughout childhood. This study examines the association between protective experiences and subsequent alcohol and binge alcohol use frequency over one month among female adolescent and emerging adults reporting high and low levels of two ACE dimensions (household dysfunction and emotional abuse/neglect). METHODS: One hundred 43 females between the ages of 15-24 who indicated at least one binge episode in the past two weeks completed the six-item ACEs scale, the PACEs scale, and demographics at baseline. Alcohol consumption was measured prospectively over the next month during weekly appointments using the timeline follow back approach. RESULTS: Two PACEs factors had significant direct associations, a source of unconditional love was associated with less frequent alcohol use (ß = -0.437, 95% confidence interval [CI] -0.744, -0.131, exp(ß) = 0.65, p = .005) in the context of high household dysfunction; and having a trusted adult to count on for help and advice (ß = -1.373, 95% CI -2.283, -0.464, exp(ß) = 0.25, p = .003) predicted fewer binge occasions in the context of high emotional abuse/neglect. Regardless of ACE dimension exposure, nonsport social group membership was associated more frequent alcohol use over the month across all ACE dimensions (ß = 0.11-0.74, 95% CI -0.11, 0.74, exp(ß) = 1.37 - 1.62, p ≤ .002); and having a trusted adult to count on for help and advice was associated with a 5.7 times more frequent of alcohol use among those with low household dysfunction (ß = 1.74, 95% CI 0.83, 2.65, exp(ß) = 5.70, p < .001). DISCUSSION: Few PACE items are associated with direct reductions in alcohol outcomes. Indeed, there is consistently heightened risk associated with nonsport group membership for alcohol use frequency, regardless of experiences of childhood adversity. Future research should identify which protective factors have the most potential to off-set alcohol use by ACE dimension.

Implementation of facemask sampling for the detection of infectious individuals with SARS-CoV-2 in high stakes clinical examinations - a feasibility study.

Introduction: SARS-CoV-2 may transmit across vaccinated cohorts during practical clinical examinations. We sought to assess the feasibility of facemask sampling (FMS) to identify individuals emitting SARS-CoV-2 during a mock PACES exam. Methods: In May 2022 we recruited participants from a mock PACES examination in Leicester, UK. Following a negative lateral flow test assay, all participants wore modified facemasks able to capture exhaled virus during the assessment (FMS). A concomitant upper respiratory tract sample (URTS) was provided prior to FMS. Exposed facemasks were processed by removal and dissolution of sampling matrices fixed within the mask and cycle thresholds values quantified by RT-qPCR. Participants were asked to grade statements regarding the comfort, effort, ethics and communication when providing FMS; laboratory technicians were asked to grade key statements surrounding suitability of samples for processing. Results: 34 participants provided concomitant URTS and FMS during the examination. One participant was positive for SARS-CoV-2, with a cycle threshold value of 22.5 on URTS, but negative (no viral RNA detected) on FMS; no transmission to others was identified from this individual. Participants responded positively to statements regarding FMS describing all four domains; however, 69% of participants felt that a positive result from FMS alone was insufficient for diagnosis and that further tests were required. All but one FMS sample was suitable for processing. Discussion: FMS during PACES exams are acceptable among participants and samples provided are suitable for processing. Our results demonstrate feasibility of FMS within practical examination settings and support the further assessment of FMS as a scalable tool that can be compared with URTS to identify those who are infectious.

The impact of positive and adverse childhood experiences on social connectedness in young adults.

Establishing and maintaining social relationships is a critical developmental milestone for adolescents and young adults and can be disrupted by childhood adversities. Adverse and positive childhood experiences (ACEs and PCEs, respectively) represent independent, yet critical, domains that support the exploration of positive and adverse childhood experiences (PACEs) as pathways to social connection. Recent research has examined the impact of COVID-19 on child development. The current study expands on existing research by examining the effects that PACEs clusters and high school enrollment during COVID-19 had on social connectedness. Young adults (N = 211; Mage = 20.97 years, SD = 2.14) completed an online survey examining social functioning and childhood experiences. Two measures comprised PACEs: Benevolent Childhood Experiences (BCEs) scale and Adverse Childhood Experiences questionnaire. An adapted Berkman-Syme Social Network Index measured social connection. High school enrollment during COVID-19 was determined by graduation year. Cluster analyses identified three PACEs profiles: (1) high BCEs/low ACEs (74.9%), (2) moderate BCEs/high ACEs (14.7%), and (3) low BCEs/moderate ACEs (10.4%). Regression analyses showed that High Risk/High Protection (ß = -3.326, p = .001) and Moderate Risk/Moderate Protection (ß = -4.845, p < .001) profiles had significantly fewer social connections than the Low Risk/High Protection profile. High school enrollment at the COVID-19 onset did not predict social connection (ß = 0.067, p = .305). Implications include clinicians considering PACEs when forming a holistic view of clients and integrating positive contexts into adversity research.

Associations of physical activity and physical education enjoyment with self-concept domains among Hungarian adolescents.

BACKGROUND: Sport enjoyment is one of the most important factors in physical activity (PA) and physical education (PE) domains. It is not only beneficial for regular participation but also has a positive effect on mental health. Due to these benefits, this study aims to understand the relationships between PA, two forms of enjoyment, and the dimension of self-concept. METHODS: The sample consisted of 315 students (Mage=12.63). The Self-Description Questionnaire-I was used to measure the domains of self-concept. Enjoyment was measured with two scales. The Physical Activity Enjoyment Scale reflects extracurricular PA enjoyment, and the Factors Influencing Enjoyment of Physical Education Questionnaire reflects school PE enjoyment. The International Physical Activity Questionnaire was used to assess vigorous, moderate, and walking types of extracurricular PA enjoyment. RESULTS: Hierarchical multivariate regression analysis revealed that vigorous PA predicted physical ability (ß = 0.19) and physical appearance (ß = 0.15). PA enjoyment was a significant predictor of general self-concept (ß = 0.29), physical ability (ß = 0.28), physical appearance (ß = 0.16), peer relation (ß = 0.16), and parental relations (ß = 0.14). PE enjoyment significantly predicted general school (ß = 0.17), physical ability (ß = 0.27), peer relations (ß = 0.21) and parental relations (ß = 0.22). Furthermore, boys scored at a higher level on most of self-concept domains. CONCLUSIONS: The present study suggested that enjoyment plays a more important role in self-concept than PA. PE enjoyment mainly strengthens boys' self-concept, but PA enjoyment is an important predictor of general self-concept in both genders. It is concluded that extracurricular PA enjoyment is beneficial, but increasing enjoyment of physical education could increase girls' self-concepts as well.

Associations of adverse and protective childhood experiences with thwarted belongingness, perceived burdensomeness, and suicide risk among sexual minority men.

BACKGROUND: Sexual minority men (SMM) experience higher suicidal ideation and suicide attempts than the general population. We examined the associations of adverse childhood experiences (ACES) and protective and compensatory childhood experiences (PACES) with suicidal ideation and suicide attempts in adulthood via thwarted belongingness and perceived burdensomeness among SMM. METHODS: Data are from the UNITE study, a national longitudinal cohort study of HIV-negative SMM from the 50 U.S. states and Puerto Rico. Between 2017 and 2019, participants (N = 6303) completed web-based assessments at baseline and 12-month follow-up. ACES and PACES occurring before the age of 18, and current symptoms of thwarted belongingness and perceived burdensomeness were assessed at baseline. Past-week suicidal ideation and past-year suicide attempt were assessed at follow-up. RESULTS: 424 (6.7%) participants reported past-week suicidal ideation and 123 (2.0%) reported a past-year suicide attempt. The results of our multivariate model suggest that each additional adverse childhood experience was prospectively associated with 14% higher odds of past-week suicidal ideation (AOR = 1.14, 95% CI 1.09-1.19) and 19% higher odds of past-year suicide attempt (AOR = 1.19, 95% CI 1.11-1.29). Each additional protective childhood experience was prospectively associated with 15% lower odds of past-week suicidal ideation (AOR = 0.85, 95% CI 0.81-0.90) and 11% lower odds of past-year suicide attempt (AOR = 0.89, 95% CI 0.82-0.98). Perceived burdensomeness partially mediated these prospective associations. CONCLUSION: To reduce suicide, screening and treating perceived burdensomeness among SMM with high ACES may be warranted. PACES may decrease perceived burdensomeness and associated suicide risk.

Bout duration and number of players of soccer small-sided games affect perceived enjoyment, physiological responses, and technical-tactical performance.

PURPOSE: To compare perceived enjoyment (PE), % of heart rate peak (%HRpeak), blood lactate (La), rating of perceived exertion (RPE), and technical-tactical performance of soccer players after four-a-side (4vs4) and three-a-side (3vs3) small-sided games (SSGs) with goalkeepers. METHODS: Sixteen males (20.7 ± 0.7 years; experience: 6.9 ± 1.2 years) completed and were measured after six sessions of SSGs (one twelve-minute bout (1x12), two six-minute bouts (2x6), and three four-minute bouts (3x4), both 3vs3 and 4vs4). Repeated measurements ANOVA evaluated significant differences (p ≤ 0.05). RESULTS: There was higher PE for 1 × 12 compared to 2 × 6 (effect sizes [ES] = 1.53 [3vs3 and 4vs4]) and 3 × 4 (ES = 3.13 [4vs4] and 4.16 [3vs3]). Continuous bout duration (1x12) was characterized by a significantly greater percentage of successful passes compared to 2 × 6 (ES = 2.57 [4vs4] and 1.79 [3vs3]) and 3 × 4 (ES = 2.14 [4vs4] and 1.73 [3vs3]), and minor ball loss rate (2x6: ES = 2.14 [4vs4] and 1.11 [3vs3]; 3x4: ES = 2.11 [4vs4] and 1.57 [3vs3]). The percentage of successful tackles was only significantly greater for 1 × 12 in 4vs4 (ES = 0.83 [2x6] and 0.86 [3x4]) and successful duels in 3vs3 (ES = 1.41 [2x6] and 1.43 [3x4]). Significantly greater %HRpeak for 1 × 12 compared to 2 × 6 (ES = 1.02 [4vs4] and 0.81 [3vs3]) and 3 × 4 (ES = 1.04 [4vs4] and 0.99 [3vs3]) was observed, La differences were only significant in 3vs3 (ES = 1.60 [2x6] and 1.30 [3x4]). Greatest RPE were encountered in 3 × 4 (4vs4) and 1 × 12 and 3 × 4 (3vs3). Significant differences existed between the 3vs3 and 4vs4 designs with a non-clear pattern of better results for neither of both. CONCLUSION: Therefore, coaches should consider longer continuous bouts when programming SSGs-based training to significantly increase PE, technical-tactical performance, and training load.

Towards a Constellation of Peaces and Developments in Colombia / Hacia una constelación de paces y desarrollos en colombia

RESUMEN Este artículo define una serie de argumentos que sustentan el vínculo estrecho entre las concepciones de paz y desarrollo, en procura de proyectar posibilidades de mayores impactos para el bienestar y la evolución humana. En el recorrido se dota a cada una de las nociones de diversos contenidos, dimensiones, atributos, dispositivos y propósitos con el fin de romper con su concepción unidimensional y dar paso a su constitución múltiple y compleja, para posteriormente definir puntos de encuentro, asocio, combinación y trabajo sinérgico entre las nociones en estudio que conlleven al reconocimiento de las paces y desarrollos circulando en una órbita más amplia. En el recorrido se reivindica las paces y desarrollos no solo como conceptos o nociones ideales, sino también como procesos, experiencias, dinámicas y acontecimientos múltiples que es necesario comprender en red. Para lograr tal reto se requirió realizar un análisis crítico de distintas revistas electrónicas, libros y declaraciones de las Naciones Unidas sobre desarrollo y paz con el fin de poder abrir el debate en lógicas de simbiosis, sinergias, complementariedades y contribuciones mutuales.

ABSTRACT This article defines a series of arguments that support the close link between the conceptions of peace and development, in an attempt to project possibilities of greater impacts on human well-being and evolution. In the journey, each of the notions is endowed with various contents, dimensions, attributes, devices, and purposes, in order to break with its one-dimensional conception and give way to its multiple and complex constitution, to later define meeting points, association, combination, and synergistic work between the notions under study that lead to the recognition of peace and developments circulating in a wider orbit. In the tour, peace and development are vindicated, not only as ideal concepts or notions, but also as processes, experiences, dynamics, and multiple events that must be understood online. To achieve this challenge, it was necessary to carry out a critical analysis of different electronic journals, books, and United Nations declarations on development and peace in order to open the debate on the logic of symbiosis, synergies, complementarities, and mutual contributions.

Affective Valence and Enjoyment in High- and Moderate-High Intensity Interval Exercise. The Tromsø Exercise Enjoyment Study.

Introduction: Exercise at high intensity may cause lower affective responses toward exercise compared with moderate intensity exercise. We aimed to elucidate affective valence and enjoyment in high- and moderate-high interval exercise. Methods: Twenty recreationally active participants (9 females, 11 males, age range: 20-51 years) underwent three different treadmill running exercise sessions per week over a 3-week period, in randomized order; (1) CE70: 45 min continuous exercise at 70% of heart rate maximum (HRmax), (2) INT80: 4 × 4 min intervals at 80% of HRmax, (3) INT90: 4 × 4 min intervals at 90% of HRmax. Pre-tests included graded submaximal steady state intensities and a test to exhaustion for determining peak oxygen uptake and HRmax. Affective valence (pleasure/displeasure) was measured before, during and after the sessions using the Feeling Scale (FS). Enjoyment was assessed before and after the sessions applying the Physical Activity Enjoyment Scale (PACES) and during the sessions using the Exercise Enjoyment Scale (EES). Results: The participants felt lower pleasure (between-sessions effect: p = 0.02, p η2: 0.13) during INT90 sessions (FS: 1.08, 95% CI: 0.35-1.92) compared with INT80 (FS: 2.35, 95% CI: 1.62-3.08, p = 0.052) and CE70 sessions (FS: 2.45, 95% CI: 1.72-3.18, p = 0.03), with no differences between INT80 and CE70 sessions (p = 1.00). There were higher enjoyment after INT80 sessions (PACES: 101.5, 95% CI: 95.7-107.3) versus CE70 sessions (PACES: 91.3 95% CI: 85.5-97.1, p = 0.046), and no differences between INT90 (PACES: 98.2, 95% CI: 92.4-103.4) and CE70 (p = 0.29) or INT80 (p = 1.00). For enjoyment during exercise, CE70 were perceived more enjoyable, and INT80 and INT90 less enjoyable in week 2 (EES: week x session: p = 0.01, p η2: 0.11; CE70: 4.3, 95% CI: 3.6-4.9, INT80: 4.6, 95% CI: 3.9-5.2, INT90: 4.0, 95% CI: 3.4-4.7) and 3 (EES: CE70: 4.2, 95% CI: 3.7-4.8, INT80: 4.8, 95% CI: 4.2-5.3, INT90: 4.3, 95% CI: 3.8-4.9) than in week 1 (EES: CE70: 3.5, 95% CI: 3.0-4.0, INT80: 5.0, 95% CI: 4.5-5.5, INT90: 4.5, 95% CI: 4.0-5.0). Conclusion: The negative affective consequences associated with high intensity interval exercise can be alleviated by keeping the intensity at or around 80% of HRmax while preserving the beneficial enjoyment responses associated with interval exercise.

The Role of Physical Activity, Enjoyment of Physical Activity, and School Performance in Learning Motivation among High School Students in Hungary.

The goal of this study was to analyze the role of physical activity, enjoyment of physical activity, and school performance in the dimensions of learning motivation (Cognitive Domain, Affective Domain, Moral Domain, Adult Pressure). A total of 249 high school students were involved in this study, ranging in age from 14 to 19 years old. A self-administered questionnaire was filled out by the participants, including questions about sociodemographic background and school performance. The International Physical Activity Questionnaire was used to assess physical activity. Learning motivation was measured by the School Motivation Inventory. The Physical Activity Enjoyment Scale was used to determine the enjoyment of physical activity. Path analyses were chosen as a statistical method to understand the associations between the variables. Our findings reveal that learning motivation was associated with school performance and enjoyment of physical activity. Physical activity did not show any direct relationship with learning motivation, but it was positively associated with school performance and enjoyment of physical activity, hence showing an indirect relationship with learning motivation. Another important finding was the role of physical activity enjoyment. It has a preventive role concerning pressure from adults since such enjoyment strengthens the intrinsic motivation of students. We believe our findings highlight the benefits of physical activity and enjoyment of physical activity in learning environments.

Variations in cardiac implantable electronic device surveillance and ancillary testing in the paediatric and congenital heart disease population: an international multi-centre survey from the Paediatric and Congenital Electrophysiology Society.

BACKGROUND: Expert guidance from scientific societies and regulatory agencies recommend a framework of principles for frequency of in-person evaluations and remote monitoring for patients with cardiac implantable electronic devices. However, there are limited data regarding adherence to recommendations among paediatric electrophysiologists, and there are no data regarding cardiac implantable electronic device-related ancillary testing. METHODS: To assess current clinical practices for cardiac implantable electronic device in-person evaluation, remote monitoring, and cardiac implantable electronic device-related ancillary testing, the Paediatric and Congenital Electrophysiology Society members were surveyed. The main outcome measures were variations in frequency of in person evaluation, frequency of remote monitoring, and cardiac implantable electronic device-related ancillary testing. RESULTS: All respondents performed in-person evaluation at least once a year, but <50% of respondents performed an in-person evaluation within 2 weeks of cardiac implantable electronic device implantation. Remote monitoring was performed every 3 months for pacemakers and implantable cardioverter defibrillators by 71 and 75% respondents, respectively. Follow-up echocardiography was performed every 2-3 years by 53% respondents for patients with >50% ventricular pacing. Majority of respondents (75%) did not perform either an exercise stress test or ambulatory Holter monitoring or chest X-ray (65%) after cardiac implantable electronic device implantation. CONCLUSION: This survey identified significant practice variations in cardiac implantable electronic device in- person evaluation, remote monitoring, and ancillary testing practices among paediatric electrophysiologists. Cardiac implantable electronic device management may be optimised by development of a paediatric-specific guidelines for follow-up and ancillary testing.

2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients: Developed in collaboration with and endorsed by the Heart Rhythm Society (HRS), the American College of Cardiology (ACC), the American Heart Association (AHA), and the Association for European Paediatric and Congenital Cardiology (AEPC) Endorsed by the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS).

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.

A Short Version of the Physical Activity Enjoyment Scale: Development and Psychometric Properties.

OBJECTIVE: The purposes of this paper were to (a) develop a new short, theory-driven, version of the physical activity enjoyment scale (PACES-S) using content analysis; and (b) subsequently to measure the psychometric properties (construct validity, internal consistency, test-retest reliability, and concurrent validity) of the PACES-S for adolescents. METHODS: Six experts used a four-point Likert scale to assess the content validity of each of the 16 items of the physical activity enjoyment scale according to a provided definition of physical activity enjoyment. Based on the results, exploratory factor analysis was used to analyze survey data from a longitudinal study of 182 individuals (Measure 1 of Study 1: 15.75 ± 3.39 yrs; 56.6% boys, 43.4% girls), and confirmatory factor analysis (Measure 2 of Study 1: 15.69 ± 3.44 yrs; 56.3% boys, 43.7% girls) was used to analyze the survey data from a cross-sectional study of 3219 individuals (Study 2; 15.99 ± 3.10 yrs; 47.8% boys, 52.2% girls) to assess the construct validity of the new measure. To assess the reliability, test-retest reliability was assessed in Study 1 and internal consistency in Study 1 and 2. For the concurrent validity, correlations with self-reported and device-based physical activity behavior were assessed in both studies. RESULTS: Four out of sixteen items were selected for PACES-S. Exploratory factor analysis and confirmatory factor analyses identified and supported its factorial validity (χ2 = 53.62, df = 2, p < 0.001; RMSEA = 0.073; CFI = 0.99; RFI = 0.96; NFI = 0.99; TLI = 0.96; IFI = 0.99). Results showed good test-retest reliability (r = 0.76) and internal consistency (a = 0.82 to 0.88). Regarding concurrent validity, the results showed positive correlations with a physical activity questionnaire (Study 1: r = 0.36), with a physical activity diary (Study 1: r = 0.44), and with accelerometer-recorded data (Study 1: r = 0.32; Study 2: r = 0.21). CONCLUSIONS: The results indicate that PACES-S is a reliable and valid instrument that may be particularly useful to measure physical activity enjoyment in large-scale studies. It shows comparable measurement properties as the long version of PACES.

An Interactive Physical-Cognitive Game-Based Training System Using Kinect for Older Adults: Development and Usability Study.

BACKGROUND: Declines in physical and cognitive functions are recognized as important risk factors for falls in older adults. Promising evidence suggests that interactive game-based systems that allow simultaneous physical and cognitive exercise are a potential approach to enhance exercise adherence and reduce fall risk in older adults. However, a limited number of studies have reported the development of a combined physical-cognitive game-based training system for fall risk reduction in older adults. OBJECTIVE: The aim of this study is to develop and evaluate the usability of an interactive physical-cognitive game-based training system (game-based exercise) for older adults. METHODS: In the development phase (Part I), a game-based exercise prototype was created by integrating knowledge and a literature review as well as brainstorming with experts on effective fall prevention exercise for older adults. The output was a game-based exercise prototype that covers crucial physical and cognitive components related to falls. In the usability testing (Part II), 5 games (ie, Fruits Hunter, Where Am I?, Whack a Mole, Sky Falls, and Crossing Poison River) with three difficulty levels (ie, beginner, intermediate, and advanced levels) were tested in 5 older adults (mean age 70.40 years, SD 5.41 years). After completing the games, participants rated their enjoyment level while engaging with the games using the Physical Activity Enjoyment Scale (PACES) and commented on the games. Descriptive statistics were used to describe the participants' characteristics and PACES scores. RESULTS: The results showed that the average PACES score was 123 out of 126 points overall and between 6.66 and 7.00 for each item, indicating a high level of enjoyment. Positive feedback, such as praise for the well-designed interactions and user-friendly interfaces, was also provided. CONCLUSIONS: These findings suggest that it is promising to implement an interactive, physical-cognitive game-based exercise in older adults. The effectiveness of a game-based exercise program for fall risk reduction has yet to be determined.

2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients.

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.

2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients.

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.

2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients: Executive summary.

Guidelines for the implantation of cardiac implantable electronic devices (CIEDs) have evolved since publication of the initial ACC/AHA pacemaker guidelines in 1984 [1]. CIEDs have evolved to include novel forms of cardiac pacing, the development of implantable cardioverter defibrillators (ICDs) and the introduction of devices for long term monitoring of heart rhythm and other physiologic parameters. In view of the increasing complexity of both devices and patients, practice guidelines, by necessity, have become increasingly specific. In 2018, the ACC/AHA/HRS published Guidelines on the Evaluation and Management of Patients with Bradycardia and Cardiac Conduction Delay [2], which were specific recommendations for patients >18 years of age. This age-specific threshold was established in view of the differing indications for CIEDs in young patients as well as size-specific technology factors. Therefore, the following document was developed to update and further delineate indications for the use and management of CIEDs in pediatric patients, defined as ≤21 years of age, with recognition that there is often overlap in the care of patents between 18 and 21 years of age. This document is an abbreviated expert consensus statement (ECS) intended to focus primarily on the indications for CIEDs in the setting of specific disease/diagnostic categories. This document will also provide guidance regarding the management of lead systems and follow-up evaluation for pediatric patients with CIEDs. The recommendations are presented in an abbreviated modular format, with each section including the complete table of recommendations along with a brief synopsis of supportive text and select references to provide some context for the recommendations. This document is not intended to provide an exhaustive discussion of the basis for each of the recommendations, which are further addressed in the comprehensive PACES-CIED document [3], with further data easily accessible in electronic searches or textbooks.

2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients.

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.