A subcommittee of the Heart Rhythm Society (HRS) published a list of five treatments and procedures electrophysiologists should avoid in patients with arrhythmias. The five “don’ts” are available on the HRS website.

The list, which was developed by the HRS Quality Improvement Subcommittee as part of the Choosing Wisely campaign, draws from clinical guidelines and evidence to identify treatments and procedures that are not optimal. The initiative aims to foster communication between physicians and patients and raise awareness about risks, cost and appropriate care.

The five recommendations are:

• Don’t implant pacemakers for asymptomatic sinus bradycardia in the absence of other indications for pacing.

• Don’t implant an implantable cardioverter-defibrillator (ICD) for the primary prevention of sudden cardiac death in patients with New York Heart Association Functional Class IV who are not candidates for either cardiac transplantation, a left ventricular assist device as destination therapy or cardiac resynchronization therapy.

• Don’t implant an ICD for the primary prevention of sudden cardiac death in patients unlikely to survive at least one year due to non-cardiac comorbidity.

• Don’t ablate the atrioventricular node in patients with atrial fibrillation when both symptoms and heart rate are acceptably controlled by well-tolerated medical therapy.

• Don’t use Vaughan-Williams Class Ic antiarrhythmic drugs (such as flecainide and encainide) as a first-line agent for the maintenance of sinus rhythm in patients with ischemic heart disease who have experienced prior MI.