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Devices for Cardiac Rhythm Abnormalities: A Guideline Update

Devices for Cardiac Rhythm Abnormalities: A Guideline Update

According to recent estimates, about 400,000 pacemakers and implantable cardioverter defibrillators (ICDs) are surgically implanted each year in the United States. In 2008, the American College of Cardiology Foundation (ACCF), American Heart Association (AHA), and the Heart Rhythm Society (HRS) released guidelines for using device therapy to manage cardiac rhythm abnormalities. Since the release of the 2008 guidelines, many clinical research advances relating to device-based therapies have emerged, says Andrew E. Epstein, MD, FAHA, FACC, FHRS. “In an effort to help clinicians keep pace with these advances, the ACCF, AHA, and HRS jointly released updated guidelines in 2012 for the use of device-based therapy in treating heart rhythm disorders. The guidelines can help in clinical decision making in most circumstances.” The 2012 update writing group included experts in device therapy, cardiovascular care, internal medicine, cardiovascular 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 Society of Thoracic Surgeons. Building on Earlier Cardiac Device Guidelines For the 2012 update, the writing group began by reviewing the 2008 recommendations. The latter are largely unchanged for standard pacing and ICD indications. However, given new data on cardiac resynchronization therapy (CRT), the 2008 guidelines were updated with CRT as its focus, especially with regard to expanding indications for this treatment (Figure 1). “CRT can significantly improve quality and quantity of life by delaying or avoiding worsening heart failure.” —Andrew E. Epstein, MD, FAHA, FACC, FHRS “Despite our improvements in managing patients with device-based therapies, it can still be challenging for physicians to select patients in whom...
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