Newest AUC Provide Clinical Guidance on Cardiac Implantable Electronic Devices
New multisociety Appropriate Use Criteria (AUC) published in JACC focus on cardiac implantable electronic devices (CIEDs), specifically ICDs, 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 heart failure sections that include 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.
Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Interventions and Imaging, Angiography, Echocardiography/Ultrasound, Nuclear Imaging
Keywords: Bradycardia, Defibrillators, Implantable, Cardiac Resynchronization Therapy, Echocardiography, Angiography, Electrophysiology, Heart Failure