Prioritisation of Cardiology Procedures

Where local arrangements for prioritisation are in place and are working well, they should continue, and this guide used for reference to check if national priorities have changed, and local arrangements need to be revised.  The cases in this guide are examples and are not intended to be comprehensive.  For some patients, based on clinical presentation and need, individual decisions, which would usually be supported by a multidisciplinary meeting, will need to be made that may affect prioritisation.

Priority 1a – emergency procedures to be performed in <24 hours

LHC + PCI (if indicated) for STEMI / OHCA

LHC + PCI (if indicated) for unstable ACS with ongoing pain, ECG changes or haemodynamic/electrical instability

Pacemaker implantation for heart block or sinus node disease with significant symptoms requiring intervention e.g. recurrent syncope

Priority 1b – procedures to be performed in <72 hours

LHC + PCI (if indicated) for unstable angina or NSTEMI with an intermediate or higher risk of adverse cardiovascular events

Pacemaker implantation for symptomatic heart block

Lead extraction for systemic sepsis

ICD/CRT-D implantation for secondary prevention following cardiac arrest or syncopal VT (required prior to discharge from hospital)

CIED generator replacements for end of life

Ablation for rapidly conducted pre-excited AF in patients with Wolff Parkinson White syndrome

Ablation for VT storm not settled with medical therapy

Priority 2 – procedures to be performed in <1 month

LHC + PCI (if indicated) for unstable angina with a low risk of adverse cardiovascular events

LHC + PCI (if indicated) for patients with high risk non-invasive functional imaging or high risk CTCA, or rapidly progressive exertional angina

Staged PCI after STEMI

Coronary angiography in patients with severe aortic valve disease

TAVI for patients with symptomatic severe aortic stenosis

Permanent pacemaker implantation for asymptomatic heart block or symptomatic sinus node disease

Urgent CIED generator replacements where advisory recommends replacing within this timescale

Urgent CIED generator replacements e.g. for ERI with no underlying rhythm

Primary prevention ICD implantation

CRT implantation for heart failure

Pacemaker and AV node ablation for ventricular rate control for atrial fibrillation

Lead extraction for isolated pocket infection / erosion

AV node ablation for CRT optimisation

Ablation for patients with ventricular tachycardia not controllable with medication

Atrial fibrillation or flutter ablation for heart failure with tachymyopathy

Priority 3 – procedures to be performed in <3 months

LHC + PCI (if indicated) for stable angina without high risk functional imaging or CTCA

CIED generator replacements for patients with a stable underlying rhythm

EPS / RFA for WPW with unclear pathway characteristics

SVT ablation for patients not well controlled on medication

AF ablation for highly symptomatic patients

DC cardioversion for AF or atrial flutter / tachycardia

Insertion of implantable cardiac monitor (loop recorder or ILR)

Percutaneous mitral valve leaflet repair

Priority 4 – procedures to be performed in >3 months

All other cardiology procedures.  This would include, CTO PCI for stable angina, ablation for symptomatic AF (excluding highly symptomatic patients), SVT ablation for patients controlled on medical therapy, ventricular ectopy ablation for symptoms.

Page last updated July 2023