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The American College of Cardiology, American Heart Association and the Heart Rhythm Society Release Updated Cardiac Device-Based Therapy Guidelines

New guidelines offer revised indications for the use of pacemakers, implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices

SAN FRANCISCO, May 15 /PRNewswire-USNewswire/ -- The American College of Cardiology (ACC), American Heart Association (AHA) and the Heart Rhythm Society (HRS) have jointly released updated cardiac device-based therapy guidelines. The ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities are the first guidelines that combine indications for all cardiac implantable electronic devices and were released today during Heart Rhythm 2008, the Heart Rhythm Society's 29th Annual Scientific Sessions.

An estimated 180,000 pacemaker devices and 91,000 implantable defibrillators were implanted in the U.S. in 2005 (1). The ability to diagnose and treat patients, and manage their devices has greatly improved in recent years. ACC, AHA and the HRS (formerly NASPE) created a committee of physicians who are expert in the areas of device therapy, cardiovascular care, internal medicine, cardiovascular surgery, ethics and socioeconomics to update device-based therapy guidelines, previously called ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices. With the overall goal of improving patient care, the updated guidelines incorporate data from recent clinical trials and the most significant advances in pacemaker and implantable cardioverter-defibrillator (ICD) therapy.

"The updated guidelines are a product of expert analysis of recent studies that have advanced our knowledge of cardiac arrhythmias as well as major advances in device technology," said writing committee chair Andrew Epstein, M.D., professor of medicine at the University of Alabama at Birmingham. "The guidelines take a patient-centered approach and will help physicians determine the most effective treatment options available for each individual patient."

The updated guidelines offer health care providers comprehensive evidence-based recommendations for the appropriate use of cardiac devices. It is the first document to comprehensively address device-based therapy indications for life-threatening cardiac arrhythmias and conditions including heart failure, congenital heart disease and sudden cardiac arrest. Guidelines also address treatment for genetic disorders such as catecholaminergic polymorphic VT, Brugada syndrome, arrhythmogenic right ventricular cardiomyopathy and short QT syndrome.

Revised ICD indications reflect the new developments and literature related to the efficacy of these devices in the treatment and prevention of sudden cardiac death and malignant ventricular arrhythmias. Indications for cardiac resynchronization therapy CRT to better synchronize or coordinate the rhythm of the heart are also clarified, and the committee determined that this therapy should only be prescribed when heart failure patients are still exhibiting symptoms while being treated with the optimal recommended medical therapy.

"Indications for ICDs, CRT devices, and combined ICDs and CRT devices are continuously changing and can be expected to change further as new trials are reported," Epstein added. "These guidelines extend and clarify current best practices and will continue to evolve as technology advances."

While the guidelines primarily focus on device indications, the committee also addressed several device and patient management issues. To ensure optimal patient outcomes, the committee called for patient and family involvement in a risk assessment prior to device implantation, including discussion of life expectancy and quality of life issues. New guidance related to ICD and pacemaker programming and management at the end of life was also included.

The guidelines will be published in the Journal of the American College of Cardiology; Circulation: Journal of the American Heart Association; and the HeartRhythm Journal. Full text of the guidelines will be posted on the ACC (, AHA ( and Heart Rhythm Society ( Web sites.

About the American College of Cardiology (ACC):

The American College of Cardiology is leading the way to optimal cardiovascular care and disease prevention. The College is a 34,000-member nonprofit medical society and bestows the credential Fellow of the American College of Cardiology upon physicians who meet its stringent qualifications. The College is a leader in the formulation of health policy, standards and guidelines, and is a staunch supporter of cardiovascular research. The ACC provides professional education and operates national registries for the measurement and improvement of quality care. For more information visit

About the American Heart Association (AHA):

Founded in 1924, the American Heart Association is the nation's oldest and largest voluntary health organization dedicated to building healthier lives, free of heart disease and stroke. These diseases, America's No. 1 and No. 3 killers, and all other cardiovascular diseases claim over 870,000 lives a year. In fiscal year 2006-07 the association invested more than $554 million in research, professional and public education, advocacy and community service programs to help all Americans live longer, healthier lives. To learn more, call 1-800-AHA-USA1 or visit

About the Heart Rhythm Society

The Heart Rhythm Society is the international leader in science, education and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education and optimal health care policies and standards. Incorporated in 1979 and based in Washington, DC, it has a membership of more than 4,800 heart rhythm professionals in more than 65 countries around the world.


(1) National Hospital Discharge Survey, 2005.

SOURCE American Heart Association
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