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Do not routinely recommend pulsed-field ablation for atrial fibrillation, except under standard arrangements for clinical governance, consent, and audit
NICE
NICE
NICE recommends not to routinely use pulsed-field ablation (PFA) for atrial fibrillation, except under standard arrangements for clinical governance, informed consent, and outcome auditing. Short-term evidence shows PFA achieves high pulmonary vein isolation rates (~99%), significant reduction in AF recurrence, and quality-of-life improvement, with lower risk of oesophageal injury and phrenic nerve palsy compared with thermal ablation. However, most data are from 12–15 month follow-up and ...
ver más ... 2025Do not routinely recommend transcatheter aortic valve implantation (TAVI) for native aortic valve regurgitation; restrict use to special arrangements in patients at high surgical risk or unsuitable ...
NICE
NICE
NICE recommends not to routinely use TAVI for native aortic valve regurgitation: In patients for whom surgical aortic valve replacement (SAVR) is unsuitable or high surgical risk, the procedure may be considered only under special arrangements for clinical governance, informed consent, and outcome auditing. Evidence comes mainly from registries and observational studies (n≈16,000 with native AR), showing technical success >90%, significant AR reduction, and 30-day mortality of 3–4% with ...
ver más ... 2025Do not routinely recommend targeted muscle reinnervation for managing post-amputation pain, except under special arrangements for secondary procedures; restrict to research for primary procedures
NICE
NICE
NICE recommends not to routinely use targeted muscle reinnervation (TMR) for post-amputation pain management. As a secondary procedure (to treat problematic pain developed after amputation), it may be used under special arrangements for clinical governance, informed consent, and outcome auditing, as evidence suggests clinically meaningful reductions in residual and phantom limb pain, improvements in quality of life, and decreased opioid use, though evidence quality is limited. As a primary ...
ver más ... 2025Do not routinely advise oral fluids or give intravenous fluids for the treatment of ketonuria in women and pregnant people who are not diabetic during labour
NICE
NICE
NICE recommends not to routinely administer oral or intravenous fluids to treat ketonuria in non-diabetic women and pregnant people during labour, as this practice is often unnecessary and may increase the risk of peripartum hyponatraemia. During pregnancy and labour, maternal physiology is associated with lower osmolality, reduced serum sodium, and an antidiuretic effect of both endogenous and exogenous oxytocin, increasing the risk of hyponatraemia. Liberal intravenous fluid use or excessive ...
ver más ... 2025Do not routinely recommend laparoscopic insertion of an inactive implant for gastro-oesophageal reflux disease, except under special arrangements in people with ineffective oesophageal motility, and ...
NICE
NICE
NICE recommends not to routinely use laparoscopic insertion of an inactive implant (RefluxStop) for GORD. In people with ineffective oesophageal motility (IOM), the procedure may be considered only under special arrangements for clinical governance, informed consent, and outcome auditing, as the evidence, while suggesting symptom improvement and PPI reduction, is limited and requires long-term follow‑up. In people without IOM, the procedure should only be performed within formal research ...
ver más ... 2025