New in Clinical Guidance | Newest AUC Provide Clinical Guidance on Cardiac Implantable Electronic Devices
A new multi-society Appropriate Use Criteria (AUC) document focuses on cardiac implantable electronic devices (CIEDs), specifically implantable cardioverter-defibrillators (ICDs), cardiac resynchronization therapy (CRT) and pacing. The updated criteria address a broad spectrum of clinical scenarios and key areas where new data are available or new procedures and technologies have resulted in changes in practice since the original AUC on CIEDs were published in 2013.
"Decisions related to CIED therapy, including timing of implantation, are often complex," says Writing Committee Co-Chair Andrea M. Russo, MD, FACC. She, along with Co-Chair Milind Y. Desai, MD, MBA, FACC, and colleagues note that the new AUC are decided to provide "guidance around the rationale and practical use of device implantation is the goal of the current document."
The AUC includes 12 comprehensive sections, covering the range of clinical scenarios from primary and secondary prevention ICDs to evolving technologies like leadless pacing and conduction system pacing. In addition, the writing group felt it was important to add additional sections on heart failure that include left ventricular assist devices (LVADs) and devices following cardiac transplantation, "because these scenarios may include complexities related to ICD indications and device management," says Russo.
Like all AUC, the new document is intended to serve as a guide in clinical decision-making and the appropriateness of patient selection and timing of therapies. Recognizing the rapid advancements in the field of electrophysiology and the subsequent complexities with choosing the optimal CIED therapy for individual patients, the document stresses the importance of shared decision-making between clinician and patients.
"Shared decision-making should always be utilized to incorporate individual patient values and preferences," according to the AUC authors. In addition, "it is important to acknowledge that patients may not always neatly fit within a given clinical scenario and that clinical judgment is always necessary for assessing device implantation for individual patients," they write.
The new AUC were developed by the ACC, in collaboration with the American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance.
Read the full document published in JACC.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Heart Failure and Cardiomyopathies, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Mechanical Circulatory Support
Keywords: Cardiology Magazine, ACC Publications, Cardiac Resynchronization Therapy Devices, Defibrillators, Implantable, Heart-Assist Devices, Electrophysiology, Cardiac Electrophysiology