ICD indications: Difference between revisions
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For all indications patient should be on optimal medical therapy and have a life expectancy of > 1 year. | For all indications patient should be on optimal medical therapy and have a life expectancy of > 1 year. | ||
==Class I== | ==Class I (recommendations)== | ||
* Patients with left ventricular dysfunction due to prior myocardial infarction who are at least 40 days post MI with LVEF <30-40%, are NYHA class II or III and are receiving chronic optimal medical therapy and with life expectancy > 1 year. IA<cite>ESCSCD</cite> | * Patients with left ventricular dysfunction due to prior myocardial infarction who are at least 40 days post MI with LVEF <30-40%, are NYHA class II or III and are receiving chronic optimal medical therapy and with life expectancy > 1 year. IA<cite>ESCSCD</cite> | ||
* LV dysfunction due to prior MI, presenting with hemodynamically unstable sustained VT. IA<cite>ESCSCD</cite><cite>ESCHF</cite> | * LV dysfunction due to prior MI, presenting with hemodynamically unstable sustained VT. IA<cite>ESCSCD</cite><cite>ESCHF</cite> | ||
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* CRTD is recommended in patients with sinus rhythm, LBBB, QRS > 120ms, EF<35%, NYHA III-IV. IA <cite>ESCHF</cite> | * CRTD is recommended in patients with sinus rhythm, LBBB, QRS > 120ms, EF<35%, NYHA III-IV. IA <cite>ESCHF</cite> | ||
==Class IIa== | ==Class IIa (should be considered)== | ||
* LV dysfunction due to prior MI, at least 40 days post MI, LVEF < 30-35%, NYHA I, on chronic medical therapy, life expectancy >1y. IIaB<cite>ESCSCD</cite> | * LV dysfunction due to prior MI, at least 40 days post MI, LVEF < 30-35%, NYHA I, on chronic medical therapy, life expectancy >1y. IIaB<cite>ESCSCD</cite> | ||
* Recurrent VT in post MI patient with normal or near normal LVEF on chronic medical therapy, life expectancy > 1y. IIaC<cite>ESCSCD</cite> | * Recurrent VT in post MI patient with normal or near normal LVEF on chronic medical therapy, life expectancy > 1y. IIaC<cite>ESCSCD</cite> | ||
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* A CRTD/CRTP may be considered to reduce the risk of HF worsening in a patient with atrial fibrillation who is pacemaker dependant, after AV nodal ablation QRS > 150ms, EF<35%, NYHA III-IV . IIaA<cite>ESCHF</cite> | * A CRTD/CRTP may be considered to reduce the risk of HF worsening in a patient with atrial fibrillation who is pacemaker dependant, after AV nodal ablation QRS > 150ms, EF<35%, NYHA III-IV . IIaA<cite>ESCHF</cite> | ||
==Class IIb== | ==Class IIb (may be considered)== | ||
* nonischemic DCM, LVEF < 30-35%, NYHA I. optimal medical therapy, LE>1y. IIbC<cite>ESCSCD</cite> | * nonischemic DCM, LVEF < 30-35%, NYHA I. optimal medical therapy, LE>1y. IIbC<cite>ESCSCD</cite> | ||
* CRT may be considered to reduce the risk of HF worsening in a patient with atrial fibrillation who requires pacing because of intrinsically slow ventricular rate with QRS > 120ms, EF<35%, NYHA III-IV . IIbC<cite>ESCHF</cite> | * CRT may be considered to reduce the risk of HF worsening in a patient with atrial fibrillation who requires pacing because of intrinsically slow ventricular rate with QRS > 120ms, EF<35%, NYHA III-IV . IIbC<cite>ESCHF</cite> | ||
* CRT may be considered to reduce the risk of HF worsening in a patient with atrial fibrillation who requires pacing because of a rate of < 60 bpm in rest and < 90 bpm on exercise with QRS > 120ms, EF<35%, NYHA III-IV . IIbC<cite>ESCHF</cite> | * CRT may be considered to reduce the risk of HF worsening in a patient with atrial fibrillation who requires pacing because of a rate of < 60 bpm in rest and < 90 bpm on exercise with QRS > 120ms, EF<35%, NYHA III-IV . IIbC<cite>ESCHF</cite> | ||
* CRT should be considered in those patient with atrial fibrillation in NYHA functional class II with an EF ≤35%, irrespective of QRS duration, to reduce the risk of worsening of HF. IIbC<cite>ESCHF</cite> | * CRT should be considered in those patient with atrial fibrillation in NYHA functional class II with an EF ≤35%, irrespective of QRS duration, to reduce the risk of worsening of HF. IIbC<cite>ESCHF</cite> | ||
==Class III (not recommended)== | |||
* ICD implantation is not recommended during the acute phase of myocarditis<cite>ESCSCD</cite> | |||
==References== | ==References== | ||
Revision as of 22:01, 10 March 2013
ICD indications
For all indications patient should be on optimal medical therapy and have a life expectancy of > 1 year.
Class I (recommendations)
- Patients with left ventricular dysfunction due to prior myocardial infarction who are at least 40 days post MI with LVEF <30-40%, are NYHA class II or III and are receiving chronic optimal medical therapy and with life expectancy > 1 year. IAESCSCD
- LV dysfunction due to prior MI, presenting with hemodynamically unstable sustained VT. IAESCSCDESCHF
- Patients with non-ischemic dilated cardiomyopathy (NI DCM) with LV dysfunction who have sustained VT or VF. IAESCSCD
- NI DCM LVEF<30-35%. NYHA II-III. Chronic medical therapy. Life expectancy > 1 year. IBESCSCD
- Hypertrophic cardiomyopathy with sustained VT or VF. IBESCSCD
- Arrhythmogenic right ventricular cardiomyopathy with documented sustained VT or VF. OMT, LE>1y.IB ESCSCD
- Sustained VT, hemodynamically unstable VT, VT with syncopy, or VF. LVEF< 40%. IAESCSCD
- LQTS with previous cardiac arrest. IAESCSCD
- Brugada syndrome with previous cardiac arrest. ICESCSCD
- CPVT with previous cardiac arrest. ICESCSCD
- An ICD is recommended in a patient with heart failure with a ventricular arrhythmia causing haemodynamic instability. LE>1y. IA ESCHF
- CRTD is recommended in patients with sinus rhythm, LBBB, QRS > 130ms, EF<30%, NYHA II. IA ESCHF
- CRTD is recommended in patients with sinus rhythm, LBBB, QRS > 120ms, EF<35%, NYHA III-IV. IA ESCHF
Class IIa (should be considered)
- LV dysfunction due to prior MI, at least 40 days post MI, LVEF < 30-35%, NYHA I, on chronic medical therapy, life expectancy >1y. IIaBESCSCD
- Recurrent VT in post MI patient with normal or near normal LVEF on chronic medical therapy, life expectancy > 1y. IIaCESCSCD
- In patients with life threatening arrhythmias who are not in the acute phase of myocarditis, on chronic medical therapy, life expectancy >1y. IIaCESCSCD
- Unexplained syncope, significant LV dysfunction, non-ischemic DCM. Optimal medical therapy, LE>1y. IIaCESCSCD
- Sustained VT with (near) normal LV function and non-ischemic DCM. Optimal medical therapy, LE>1y. IIaCESCSCD
- Hypertrophic cardiomyopathy with one or more major risk factors. Optimal medical therapy, LE>1y. IIaCESCSCD
- Arrhythmogenic right ventricular cardiomyopathy with extensive disease, including those with LV dysfunction 1 or more affected family members with SCD, or undiagnosed syncope when VT or VF has not been excluded as the cause of syncope. OMT, LE>1y.IB ESCSCD
- CRTD, NYHA III/IV, SR, QRS>120ms. IIaB. ESCSCD
- LQTS with syncope and / or VT while on beta blockers. ESCSCD
- Brugada syndrome with spontaneous type I ECG and who have had syncope. ESCSCD
- Brugada syndrome with documented VT that has not resulted in cardiac arrest. ESCSCD
- A CRTD should be considered in a patient with non-LBBB, QRS > 150ms, EF<35%, NYHA III-IV . IIaAESCHF
- A CRTD should be considered in a patient with non-LBBB, QRS > 150ms, EF<30%, NYHA II . IIaAESCHF
- A CRTD/CRTP may be considered to reduce the risk of HF worsening in a patient with atrial fibrillation who is pacemaker dependant, after AV nodal ablation QRS > 150ms, EF<35%, NYHA III-IV . IIaAESCHF
Class IIb (may be considered)
- nonischemic DCM, LVEF < 30-35%, NYHA I. optimal medical therapy, LE>1y. IIbCESCSCD
- CRT may be considered to reduce the risk of HF worsening in a patient with atrial fibrillation who requires pacing because of intrinsically slow ventricular rate with QRS > 120ms, EF<35%, NYHA III-IV . IIbCESCHF
- CRT may be considered to reduce the risk of HF worsening in a patient with atrial fibrillation who requires pacing because of a rate of < 60 bpm in rest and < 90 bpm on exercise with QRS > 120ms, EF<35%, NYHA III-IV . IIbCESCHF
- CRT should be considered in those patient with atrial fibrillation in NYHA functional class II with an EF ≤35%, irrespective of QRS duration, to reduce the risk of worsening of HF. IIbCESCHF
Class III (not recommended)
- ICD implantation is not recommended during the acute phase of myocarditisESCSCD
References
<biblio>
- ESCSCD pmid=16935866
- ESCHF pmid=22828712
</biblio>