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The Arrhythmia Alliance is a charity which represents the interests of patients, carers and professionals in the field of cardiac arrhythmia. Its constituent members include Heart Rhythm UK, the professional body which represents cardiac electrophysiologists, clinical cardiac physiologists and arrhythmia nurses who treat patients with cardiac arrhythmia, and several charities including STARS (the Syncope Trust), SADS UK (the sudden adult death trust) and the Cardiomyopathy Association. This statement has been produced in collaboration with members of the Council of Heart Rhythm UK.
We welcome the changes that have been made since the Appraisal Consultation Document on cardiac resynchronisation therapy (CRT) was issued in November 2006. Our major objection to that document was that the proposed indications for CRT with a defibrillator (CRT-D) did not take account of the recent NICE Health Technology Appraisal on implantable cardioverter-defibrillators which had been issued in January 2006 (Appraisal guidance 95). That objection has now been satisfactorily addressed in section 1.2 of this Final Appraisal Determination. Our other objection was the proposed ratio of CRT pacemaker to CRT-defibrillator (90:10). We note that that figure has been removed.
We realise that there are areas for further research in the field of CRT. These include:
.The place of CRT in patients with atrial fibrillation
.The need for better techniques to recognise likely non-responders, and to improve the response rate with CRT
.The place of “Primary-prevention” CRT-D in patients with idiopathic dilated cardiomyopathy
.The need for better risk stratification to identify which patients might need back-up defibrillation therapy
We thank the NICE Appraisal Committee and project team for taking account of our suggestions and we congratulate them on their efforts.
Yours sincerely
Derek T Connelly, MD, FRCPTrudie Lobban Adam P Fitzpatrick, MD, FRCP
A-A Trustee & HRUK PresidentTrusteeTrustee
2nd April 2007
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