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ACCF, AHA and HRS update CRT guidelines

Issue: October 2012

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The American College of Cardiology Foundation, American Heart Association and Heart Rhythm Society have released joint updated guidelines for the use of device-based therapies in treating heart rhythm disorders.

Of note, the update includes expanded indications for cardiac resynchronization therapy. The revisions reflect new evidence that patients with mild HF or NYHA Class II should also be considered for CRT based on ECG results.

“These are patients who had previously been excluded from receiving CRT, but studies have shown they can benefit from this procedure. It can really improve their lives by delaying or avoiding worsening HF,” writing group chair Cynthia M. Tracy, MD, of George Washington University, said in a press release issued by the ACCF.

Another focus of the guidelines is recommendations for which patients are most likely to benefit from CRT; for example, patients with wide left bundle-branch block complexes as seen on ECG.

“There is growing evidence that patients with the widest, most abnormal looking ECG potentially benefit most compared to patients whose ECG are less abnormal,” Tracy said in the release.

The writing group compiled and examined the best evidence to date to provide physicians with a clear indication for which patients are most likely to benefit from device-based therapies. In addition, other modifications were made to help physicians determine which patients with AF might benefit from CRT. The committee also summarized the minimum frequency of in-person and remote monitoring of patients with CV implantable electronic devices, according to information in the release.

The original Guidelines for Device-based Therapy of Cardiac Rhythm Abnormalities were issued in 2008 and became the first to combine indications for all cardiac implantable electronic devices. The writing group reviewed these earlier recommendations and, other than the new and modified recommendations for CRT, they remain unchanged, according to the release.

“The … practice guidelines are intended to assist health care providers in clinical decision making by describing a range of generally acceptable approaches to the diagnosis, management and prevention of specific diseases or conditions. The guidelines attempt to define practices that meet the needs of most patients in most circumstances,” a preamble to the guidelines document stated.

The writing group included experts in device therapy, CV care, internal medicine, CV surgery, and pediatric and adult electrophysiology. The guidelines were also developed in collaboration with the American Association for Thoracic Surgery, Heart Failure Society of America and The Society of Thoracic Surgeons.

For more information:

Tracy CM. Circulation. 2012;doi:10.1161/CIR.0b013e3182618569.

Tracy CM. J Am Coll Cardiol. 2012;doi:10.1016/j.jacc.2012.07.009.

Disclosure: See the full document for a list of relevant financial disclosures.