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Guidelines offer indications for use of cardiac-based therapies
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The American College of Cardiology, American Heart Association and Heart Rhythm Society have jointly released the 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities – providing guidance for the implantation of cardiac implantable electronic devices. The revised guidelines offer comprehensive evidence-based recommendations for appropriate use of cardiac implantable devices to treat a variety of conditions including bradycardias, tachycardias, HF and genetic heart diseases.
"Recent recalls and advisories have interfered with the trust of the public with physicians, especially cardiologists. We have a credibility issue,"� Task Force Chair Andrew Epstein, MD, said. "[These guidelines] say, 'Yes we do care about you, we don't just care about implanting a device.'
The guidelines provide recommendations based on the best current clinical trial data we have available to help maximize not only survival but also quality of life.
The guidelines reflect new developments related to recent studies and knowledge of cardiac arrhythmias and major advances in device technology, including pacemaker and implantable cardioverter defibrillator therapy.
For example, the committee clarified indications for cardiac resynchronization therapy: It should only be prescribed when patients with HF who still have significant symptoms while being treated with optimal recommended medical therapy.
Additionally, the writing committee addressed treatment for genetic disorders such as the Long QT Syndrome, Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia, and device and patient management issues, including patient and family involvement in risk assessment prior to device implantation.
These indications are "continuously changing and can be expected to change further as new trials are reported,"� Epstein said.
The guidelines are published in the Journal of the American College of Cardiology, Circulation and HeartRhythm.
It is appropriate for guidelines to undergo continuous evaluation and updating as new studies provide additional information on how to improve our care of patients. When we first published these guidelines, we expected that they would undergo timely scrutiny, with appropriate changes as necessary. This is what the committee has done.
– Douglas P. Zipes, MD
Cardiology Today Section Editor