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NICE guidance on implantable cardiac devices

Implantable cardiac devices offer an “important” option for the treatment and prevention of life-threatening arrhythmias and heart failure, according to draft guidance from the National Institute for Health and Care Excellence.

Implantable cardioverter defibrillators (ICDs) are used to treat patients with ventricular arrhythmias while cardiac resynchronisation therapy (CRT) is for heart failure patients.

Arrhythmia, which sees the heart beat irregularly or slower/faster than normal, is caused by an abnormality in the heart muscle or the heart’s electrical conduction system.

Ventricular arrhythmias – irregular heartbeats which originate in the lower chambers of the heart – most commonly affect people who have underlying heart disease and can occur without warning, sometimes causing sudden death.

More than 50,000 people in England die every year from “fast” arrhythmias in the ventricles – conditions known as ventricular tachycardia or ventricular fibrillation. Those who survive face a high risk of further arrhythmias and are usually treated with an ICD.

The small battery powered device, placed in the upper chest below the left shoulder, has leads which go down a vein into the heart to control the pace of the heartbeat, check for irregular heartbeat and deliver a small electric shock (defribrillate) to return the heartbeat to its normal rhythm if required.

CRT, which is also known as cardiac resynchronisation pacemaker (CRT-P), works by bringing the pumping action of the heart’s chambers back in sync with each other to improve the heart’s pumping efficiency.

CRT-D, another type of CRT, combines CRT-P and ICD devices to both improve the heart’s pumping efficiency and defibrillate the heart internally if there is an acute arrhythmic event.

Professor Carole Longson, NICE health technology evaluation centre director, said anti-arrhythmic drugs are often ineffective, can have unpleasant side-effects and sometimes need frequent dose adjustments “which can be demanding for patients and lead to missing doses, taking the wrong dose or overdose”.

She said: “The committee heard that patients who survive a cardiac arrest, or who have a higher risk of sudden death due to ventricular arrhythmia, live in constant fear of death.

“Heart failure, particularly of the severity covered by this guidance, can be both distressing and have a significant negative impact on a person’s quality of life. Implantable devices therefore represent an important option for both the treatment and prevention of potentially life-threatening arrhythmias and heart failure.”

She stressed that the report was only draft guidance at this stage, with NICE yet to issue final guidance to the NHS, and until then NHS bodies should make decisions locally on the funding of specific treatments.

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