ESCEuropace(2023)25,1249-1276EHRA DOCUMENTEuropean Society https://doiorg/10.1093/europace/euac123of CardiologyEHRA expert consensus document on themanagement of arrhythmias in frailtysyndrome,endorsed by the Heart RhythmSociety (HRS),Asia Pacific Heart RhythmSociety (APHRS),Latin America Heart RhythmSociety (LAHRS),and Cardiac ArrhythmiaSociety of Southern Africa(CASSA)Irina Savelieva(Chair)1*,Stefano Fumagalli(Co-Chair),Rose Anne Kenny (Co-Chair),Stefan Anker45.47,Athanase BenetosGiuseppe BorianiJared Bunch0,Nikolaos Dagres Sergio DubnerLaurent Fauchier 14,Luigi Ferrucci15,Carsten Israel1,Hooman Kamel17,Deirdre A.Lane Gregory Y.H.Lip201,Niccolo MarchionniIsrael Obel3,Ken Okumura,Brian Olshansky6,7,Tatjana PotparaMartin K.Stiles30,Juan Tamargo 31,and Andrea Ungar2Document Reviewers:Jedrzej Kosiuk(EHRA Review Coordinator)32,Torben Bjerregaard Larsen33,Borislav Dinov32,Heidi Estner34,Rodrigue Garcia35,Francisco Manuel Moscoso Costa36,Rachel Lampert37,Yenn-Jiang Lin38,Ashley Chin39,Heliodoro Antonio Rodriguez40,Timo Strandberg1,and Tomasz Grodzicki2Cardovascubr Cinical Academic Group,Molecular and Clnical Sciences Research Insttute St George's University of London London,UK:Department of Experimental and Oinical MedicheGeriatre Intensive Care Unit and Gerbtric Arrhythmia Unit.Uhiversity of Rorence and AOU Caregi Porence ltaly:Mercer's Insttute for Successfu Ageing Department of Medcal Gerontobgy.St James's Hospita Dublin Ireland:Department of Cardiobgy (CVK.Gemmany:Berlin-Brandenburg Center for Regenerative Therapies(BCRT).Gemmany:German Centre for CardovasalarResearch (DZHK perer ste Berin.GemmanyCharte Universitatsmedizn Berin.Germany.Department of Gertatrkc Medcine CHRU de Nancy and INSERM U1116.Universte de LomaheNancy.France:Cardiobgy Divson,Department of Biomedica,Metabolc and Neural Sciences Uhiversity of Modena and Reggio Emila Polidinicod Modena Moden ltaly:HRS representative)IntermountainMedcalCenter.Cardology Department.Sat Lake ty.Utah USA:StanfordUniversity.Department of lntemd Medcine.PabAto.CA USA:Heart Center Lip Departmentof Electrophysobgy.Leipz Gemany(LAHRS representative)Cnca Suto Argentina Cardioby Department Buenos Aires Captal Federal Argentn"Centre Hosptaler UniversitireTrousseau et Unversite Frangos Rabebis Tours FranceNaional Insttuteon Agng MD.USAEvangelisches Krankenhaus Bidefe GmbH.Bielefeld Germany.Department of NeurobgyWell Comell Medical College New York NY.USA:Lverpool Centre for Cardiovasculr Scence.University of Lverpool Liverpool Uhited KingdomDepartment of Cardiovascuar andMetabolic Medcine,Institute of Lfe Course and Medcal Scences Uhiversty of Liverpool,Liverpool United KingdomLverpool Heart and Chest Hosptal Liverpool,Uhited Kingdom:AalborgThrombosis Research Unt.Department of Cnical Mediche AalborgUnversity.Aalborg,DemmarkDepartment of Epermenta and nicaMedcine GeneraCardology Dision.Unversity ofRorence and AOU Careggi Porence Italy:(CASSA representative):Mipark Hosptal Cardobgy Unit Johamesburg South Africa