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Updated guidance from NICE on implantable defibrillators: does it work in real life?
  1. Martin R Cowie
  1. Correspondence to Professor Martin R Cowie, National Heart & Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, UK; m.cowie{at}

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The National Institute for Health and Care Excellence (NICE) was set up (under a slightly different name) in 1999 as a public body independent of the UK government, with the remit to reduce the variation in the availability and quality of NHS treatments and care in England. It has published numerous clinical guidelines and technology appraisals and is well respected around the world for its robust and transparent assessment of the evidence and the opportunity it gives relevant stakeholders to input to the assessment process. In June 2014, it published its 314th technology appraisal (TA314),1 updating its guidance on the use of implantable defibrillator (ICD) technology and merging this with an update on its guidance on the use of cardiac resynchronisation technology (CRT).

In the absence of new trial evidence, TA314 made the same recommendations for the secondary prevention of sudden cardiac death as in its previous guidance (TA95, January 2006): ICDs continued to be recommended for people who had survived a cardiac arrest caused by either ventricular tachycardia (VT) or ventricular fibrillation, or had spontaneous sustained VT causing syncope or significant haemodynamic compromise, or had sustained VT without syncope or cardiac arrest and a left ventricular ejection fraction (LVEF)≤35% and symptoms no worse than New York Heart Association (NYHA) Class III. Those with a familial cardiac condition with a high risk of sudden death (such as long QT syndrome, Brugada syndrome, hypertrophic cardiomyopathy or arrhythmogenic right ventricular dysplasia) or surgically repaired congenital heart disease also continued to be included in the recommendations as candidates for an ICD.

In contrast, there were major changes in the guidance related to the primary prevention of sudden death. The guidance was no longer limited to ischaemic cardiomyopathy, and the use of Holter monitoring and electrophysiological studies to test the inducibility of VT …

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  • Competing interests MRC has received research funding through his University from Medtronic, Boston Scientific and St Jude Medical. He has also received speakers fees and sat on advisory panels for these companies.

  • Provenance and peer review Commissioned; internally peer reviewed.

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