The Heart Rhythm Society has released a list of potentially unnecessary treatments and procedures related to heart rhythm disorders

The list is part of the Choosing Wisely initiative, launched during 2012 by the ABIM Foundation, with the intent of reducing the use of procedures and tests not supported by clinical research, according to a press release. The recommendations included in the Heart Rhythm Society (HRS) list were selected by its quality improvement subcommittee according to current available evidence.

The recommendations are as follows:

Do not implant pacemakers for the treatment of asymptomatic sinus bradycardia in the absence of other indications for pacing. According to the HRS, there is no definitive evidence of benefit in this population, and “inappropriate right ventricular pacing” can negatively impact heart function.

Do not use implantable cardioverter-defibrillators for the primary prevention of sudden cardiac death in patients with NYHA class IV HF who are not candidates for cardiac transplantation, a left ventricular assist device as destination therapy or cardiac resynchronization therapy.

Do not implant an ICD for the primary prevention of sudden cardiac death in patients with a low probability of 1-year survival due to noncardiac comorbidity.

Do not ablate the atrioventricular node in patients with atrial fibrillation whose heart rate and symptoms are adequately controlled by well-tolerated medical therapy. “According to current professional society clinical guidelines, the risks of [atrioventricular] node ablation outweigh the benefits among [these] patients,” the release stated.

Do not use antiarrhythmic medications of Vaughan-Williams Class Ic as first-line therapy for sinus rhythm maintenance in patients with ischemic heart disease and prior MI, due to increased mortality risk among recipients following MI.

“As leaders in the treatment of cardiac arrhythmias, the Heart Rhythm Society has a responsibility to make sure that our patients are receiving the best treatment options available,” society president Hugh Calkins, MD, FHRS, stated in the release. “The HRS Choosing Wisely list will help electrophysiologists identify treatments and procedures that may not be required and instead focus on high-quality care that will save our patients time and money.”

Source: www.healio.com