ICD indications: Difference between revisions

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ICD indications
An overview of ICD and CRT(D) indications as recommended by the ''European Society of Cardiology''. For all indications patient should be on optimal medical therapy and have a life expectancy of > 1 year.
 
==Class I (recommendations)==
For all indications patient should be on optimal medical therapy and have a life expectancy of > 1 year.
==Class I==
* 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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* CPVT with previous cardiac arrest. IC<cite>ESCSCD</cite>
* CPVT with previous cardiac arrest. IC<cite>ESCSCD</cite>
* An ICD is recommended in a patient with heart failure with a ventricular arrhythmia causing haemodynamic instability. LE>1y. IA <cite>ESCHF</cite>
* An ICD is recommended in a patient with heart failure with a ventricular arrhythmia causing haemodynamic instability. LE>1y. IA <cite>ESCHF</cite>
* CRTD is recommended in patients with sinus rhythm, LBBB, QRS > 130ms, EF<30%, NYHA II. IA <cite>ESCHF</cite>
* CRTD is recommended in patients with sinus rhythm, LBBB, QRS > 130ms, EF<30%, NYHA II. IA <cite>ESCHF</cite><cite>ESCfocusedup</cite>
* 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><cite>ESCfocusedup</cite>
* CRT in patient with an other Class I pacemaker indication who is in NYHA III/IV, LVEF ≤35%, QRS ≥120 ms. IB<cite>ESCsyncope</cite>
* Syncope, documented VT and structural heart disease. IB <cite>ESCsyncope</cite>
* When monomorphic VT is induced at EP study in patients with previous myocardial infarction and syncope. IB <cite>ESCsyncope</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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* Unexplained syncope, significant LV dysfunction, non-ischemic DCM. Optimal medical therapy, LE>1y. IIaC<cite>ESCSCD</cite>
* Unexplained syncope, significant LV dysfunction, non-ischemic DCM. Optimal medical therapy, LE>1y. IIaC<cite>ESCSCD</cite>
* Sustained VT with (near) normal LV function and non-ischemic DCM. Optimal medical therapy, LE>1y. IIaC<cite>ESCSCD</cite>
* Sustained VT with (near) normal LV function and non-ischemic DCM. Optimal medical therapy, LE>1y. IIaC<cite>ESCSCD</cite>
* Hypertrophic cardiomyopathy with one or more major risk factors. Optimal medical therapy, LE>1y. IIaC<cite>ESCSCD</cite>
* HCM with high risk (>5% in 5y): http://doc2do.com/hcm/webHCM.html <cite>ESCHCM</cite>
* 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 <cite>ESCSCD</cite>
* 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 <cite>ESCSCD</cite>
* CRTD, NYHA III/IV, SR, QRS>120ms. IIaB. <cite>ESCSCD</cite>
* CRTD, NYHA III/IV, SR, QRS>120ms. IIaB. <cite>ESCSCD</cite>
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* Brugada syndrome with documented VT that has not resulted in cardiac arrest. <cite>ESCSCD</cite>
* Brugada syndrome with documented VT that has not resulted in cardiac arrest. <cite>ESCSCD</cite>
* A CRTD should be considered in a patient with non-LBBB, QRS > 150ms, EF<35%, NYHA III-IV . IIaA<cite>ESCHF</cite>
* A CRTD should be considered in a patient with non-LBBB, QRS > 150ms, EF<35%, NYHA III-IV . IIaA<cite>ESCHF</cite>
* A CRTD should be considered in a patient with non-LBBB, QRS > 150ms, EF<30%, NYHA II . IIaA<cite>ESCHF</cite>
* A CRTD should be considered in a patient with non-LBBB, QRS > 150ms, EF<30%, NYHA II . IIaA<cite>ESCHF</cite><cite>ESCfocusedup</cite><cite>ESCfocusedup</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>
* 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 > 130ms, EF<35%, NYHA III-IV . IIaA<cite>ESCHF</cite><cite>ESCfocusedup</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 > 130ms, EF<35%, NYHA III-IV . IIaC<cite>ESCHF</cite><cite>ESCfocusedup</cite>
* In patients with documented VT with inherited cardiomyopathies or channelopathies. IIaB. <cite>ESCsyncope</cite>
* CRT in patient with an other Class I pacemaker indication who is in NYHA III/IV, LVEF ≤35%, QRS <120 ms. IIaC<cite>ESCsyncope</cite>


==Class IIb==
==Class IIb (may be considered)==
* ICD implantation is not recommended during the acute phase of myocarditis<cite>ESCSCD</cite>
* 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 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 in patient with an other Class I pacemaker indication who is in NYHA II, LVEF ≤35%, QRS <120 ms. IIbC<cite>ESCsyncope</cite>


==Class III (not recommended)==
* ICD implantation is not recommended during the acute phase of myocarditis<cite>ESCSCD</cite>


==References==
==References==
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#ESCSCD pmid=16935866
#ESCSCD pmid=16935866
#ESCHF pmid=22828712  
#ESCHF pmid=22828712  
#ESCsyncope pmid=19713422
#ESCfocusedup pmid=20801924
#ESCHCM pmid=25173338
</biblio>
</biblio>