This guidance has been replaced by TA314 Arrhythmias - ICDs & Heart failure - cardiac resynchronisation

Cardiac resynchronisation therapy using a pacing device is recommended as a possible treatment for people with heart failure where all of the following circumstances apply.

  • They have moderate to severe symptoms of heart failure that are affecting their daily life, measuring class 3 or class 4 in the New York Heart Association classification system.
  • Their heart is beating regularly but an electrocardiogram (ECG) shows that the electrical system of the heart is not working properly.
  • Their left ventricular ejection fraction or LVEF for short (the amount of blood pumped out by the left side of the heart) is below 35%.
  • They are taking the drug treatment that is most effective for them.

NICE has said that a different type of pacing device, containing a defibrillator, may be considered for people with heart failure if:

Their heart failure is suitable for treatment with a pacing device - in other words, all the circumstances in the list above apply.

And it is also suitable for treatment with a device called an implantable cardioverter defibrillator.

Change to the funding direction

NICE has advised the Department of Health that, because the recommendations in this guidance require an increase in the number of cardiologists and clinical staff who are trained in CRT, and in the number of implantation centres, it will take 18 months for the NHS to be in a position to fully implement it.

The Department of Health has considered this advice and has decided to extend the direction requiring the NHS to fund treatments recommended in NICE technology appraisal guidance.

Full details of the amendment to the funding direction for this appraisal are available on the Department of Health's website.


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