Device-Based Therapy of Cardiac Rhythm Abnormalities

44 Pages·2008·0.67 MB·English

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ACC/AHA Pocket Guideline
Based on the ACC/AHA/HRS
2008 Guidelines
Device-Based
Therapy of
Cardiac Rhythm
Abnormalities
May 2008

Device-Based
Therapy of
Cardiac Rhythm
Abnormalities
May 2008
Writing Committee
Andrew E. Epsten, MD, FACC, FAHA, FHRS, Char
John P. DMarco, MD, PhD, FACC, FAHA, FHRS
Kenneth A. Ellenbogen, MD, FACC, FAHA, FHRS
N.A. Mark Estes III, MD, FACC, FAHA, FHRS
Roger A. Freedman, MD, FACC, FHRS
Leonard S. Gettes, MD, FACC, FAHA
Gabrel Gregoratos, MD, FACC, FAHA
A. Marc Gllnov, MD, FACC, FAHA
Stephen C. Hammll, MD, FACC, FHRS
Davd L. Hayes, MD, FACC, FAHA, FHRS
Mark A. Hlatky, MD, FACC, FAHA
L. Krstn Newby, MD, FACC, FAHA
Rchard L. Page, MD, FACC, FAHA, FHRS
Mark H. Schoenfeld, MD, FACC, FAHA, FHRS
Mchael J. Slka, MD, FACC
Lynne Warner Stevenson, MD, FACC, FAHA
Mchael O. Sweeney, MD, FACC

© 2008 American College of Cardiology Foundation
and American Heart Association, Inc.
The following material was adapted from the
ACC/AHA/HRS 2008 Guidelines for Device-Based
Therapy of Cardiac Rhythm Abnormalities. For a copy
of the summary article (J Am Coll Cardiol 2008;51:
2085–105; Circulation 2008;117:2820–40) and full
report, visit our Web sites at http://www.acc.org or
http://www.americanheart.org or call the ACC
Resource Center at 1-800-253-4636, ext. 5603.
Contents
I. Introduction ................................................... 4
II. Recommendations for Permanent Pacing
in Sinus Node Dysfunction .......................................13
III. Recommendations for Acquired ..............................15
Atrioventricular Block in Adults
IV. Recommendations for Permanent Pacing
in Chronic Bifascicular Block .....................................19
V. Recommendations for Permanent Pacing
After the Acute Phase of Myocardial Infarction ...................21
VI. Recommendations for Permanent Pacing in Hypersensitive
Carotid Sinus Syndrome and Neurocardiogenic Syncope ...........23
VII. Recommendations for Pacing After Cardiac Transplantation ....24
VIII. Recommendations for Permanent Pacemakers That
Automatically Detect and Pace to Terminate Tachycardias .........25

IX. Recommendations for Pacing to Prevent Tachycardia ...........26
X. Recommendation for Pacing to Prevent Atrial Fibrillation .......27
XI. Recommendations for Cardiac Resynchronization Therapy
in Patients With Severe Systolic Heart Failure .....................27
XII. Recommendations for Pacing in Patients
With Hypertrophic Cardiomyopathy ..............................29
XIII. Recommendations for Permanent Pacing in Children,
Adolescents, and Patients With Congenital Heart Disease ..........30
XIV. Recommendations for
Implantable Cardioverter-Defibrillators ..........................33
XV. Recommendations for Implantable
Cardioverter-Defibrillators in Pediatric Patients
and Patients With Congenital Heart Disease ......................38

I. Introduction
The focus of these gudelnes s the approprate
use of heart rhythm devces (pacemakers for
bradyarrhythmas and heart falure management,
e.g., cardac resynchronzaton, and mplantable
cardoverter-defbrllators [ICDs]), not the treatment
of cardac arrhythmas. The fact that the use of a
devce for treatment of a partcular condton s
lsted as a Class I ndcaton (benefcal, useful,
and effectve) does not preclude the use of other
therapeutc modaltes that may be equally effec-
tve. As wth all clncal practce gudelnes, the
recommendatons n ths document focus on
treatment of an average patent wth a specfc

dsorder and may be modfed by patent comor-
bdtes, lmtaton of lfe expectancy because of
coexstng dseases, and other stuatons that
only the prmary treatng physcan may evaluate
approprately.
The recommendatons lsted n ths document are,
whenever possble, evdence based. The schema
for classfcaton of recommendatons and level
of evdence s summarzed n Table 1, whch also
llustrates how the gradng system provdes an
estmate of the sze of the treatment effect and an
estmate of the certanty of the treatment effect.
The followng represents a subset of recommenda-
tons for the mplantaton of antarrhythma devces.
We chose to provde only recommendatons n the
pocket gude and recommend readers access the
full-text and executve summary documents for
more explanaton. Table 2 and Figures 1 and 2 are
provded to help practtoners choose whch pacng
devce s approprate for an ndvdual patent.

Table 1. Applying Classification of
Recommendations and Level of Evidence
SIzE oF TREATMENT EFFECT
CLASS I CLASS IIA
Benefit >>> Risk Benefit >> Risk
Procedure/Treatment Additional studies with
shOuLD be performed/ focused objectives needed
administered IT Is ReasOnabLe to per-
form procedure/administer
treatment
t
C LeveL A n Recommendation that n Recommendation in favor
E
f procedure or treatment of treatment or procedure
f Multiple populations
t E evaluated* is useful/effective being useful/effective
En Data derived from multi- n sufficient evidence from n some conflicting evidence
M multiple randomized trials from multiple randomized
t ple randomized clinical
A or meta-analyses trials or meta-analyses
E trials or meta-analyses
R
t
f
on) o LLiemvieteLd B populations pnr oRceecdoumrem oern tdraetaiotmn ethnat t onf Rtreecaotmmemnet nodra ptrioonc eind ufraev or
Si evaluated* is useful/effective being useful/effective
ECi Data derived from a n Limited evidence from n some conflicting evidence
PR single randomized trial or single randomized trial or from single randomized trial
y ( nonrandomized studies nonrandomized studies or nonrandomized studies
t
n
Ai
Rt LeveL C n Recommendation that n Recommendation in favor
CE Very limited populations procedure or treatment is of treatment or procedure
of evaluated* useful/effective being useful/effective
tE Only consensus opinion n Only expert opinion, case n Only diverging expert
MA of experts, case studies, studies, or standard of care opinion, case studies,
ti or standard of care or standard of care
S
E
suggested phrases for should is reasonable
writing recommendations† is recommended can be useful/effective/beneficial
is indicated is probably recommended
is useful/effective/beneficial or indicated