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ICD indications: Difference between revisions
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(Created page with "ICD indications ==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 NHA class I...") |
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ICD indications | ICD indications | ||
For all indications patient should be on optimal medical therapy and have a life expectancy of > 1 year. | |||
==Class I== | ==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 | * 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 | * LV dysfunction due to prior MI, presenting with hemodynamically unstable sustained VT. IA<cite>ESCSCD</cite><cite>ESCHF</cite> | ||
* Patients with non-ischemic dilated cardiomyopathy (NI DCM) with LV dysfunction who have sustained VT or VF. IA | * Patients with non-ischemic dilated cardiomyopathy (NI DCM) with LV dysfunction who have sustained VT or VF. IA<cite>ESCSCD</cite> | ||
* NI DCM LVEF<30-35%. NYHA II-III. Chronic medical therapy. Life expectancy > 1 year. IB | * NI DCM LVEF<30-35%. NYHA II-III. Chronic medical therapy. Life expectancy > 1 year. IB<cite>ESCSCD</cite> | ||
* Hypertrophic cardiomyopathy with sustained VT or VF. IB | * Hypertrophic cardiomyopathy with sustained VT or VF. IB<cite>ESCSCD</cite> | ||
* Arrhythmogenic right ventricular cardiomyopathy with documented sustained VT or VF. OMT, LE>1y.IB <cite>ESCSCD</cite> | |||
* Sustained VT, hemodynamically unstable VT, VT with syncopy, or VF. LVEF< 40%. IA<cite>ESCSCD</cite> | |||
* LQTS with previous cardiac arrest. IA<cite>ESCSCD</cite> | |||
* Brugada syndrome 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, who is expected to | |||
>1 year with good functional status, to reduce the risk of sudden death. 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 > 120ms, EF<35%, NYHA III-IV. IA <cite>ESCHF</cite> | |||
==Class IIa== | ==Class IIa== | ||
* 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 | * 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 | * Recurrent VT in post MI patient with normal or near normal LVEF on chronic medical therapy, life expectancy > 1y. IIaC<cite>ESCSCD</cite> | ||
* In patients with life threatening arrhythmias who are not in the acute phase of myocarditis, on chronic medical therapy, life expectancy >1y. IIaC | * In patients with life threatening arrhythmias who are not in the acute phase of myocarditis, on chronic medical therapy, life expectancy >1y. IIaC<cite>ESCSCD</cite> | ||
* Unexplained syncope, significant LV dysfunction, non-ischemic DCM. Optimal medical therapy, LE>1y. IIaC | * 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 | * 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 | * Hypertrophic cardiomyopathy with one or more major risk factors. Optimal medical therapy, LE>1y. IIaC<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> | |||
* LQTS with syncope and / or VT while on beta blockers. <cite>ESCSCD</cite> | |||
* Brugada syndrome with spontaneous type I ECG and who have had syncope. <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<30%, NYHA II . IIaA<cite>ESCHF</cite> | |||
* A CRTD/CRTP may be considered to reduce the risk of HF worsening in a patient who is pacemaker dependant, after AV nodal ablation QRS > 150ms, EF<35%, NYHA III-IV . IIaA<cite>ESCHF</cite> | |||
==Class IIb== | ==Class IIb== | ||
* ICD implantation is not recommended during the acute phase of myocarditis | * 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 | * nonischemic DCM, LVEF < 30-35%, NYHA I. optimal medical therapy, LE>1y. IIbC<cite>ESCSCD</cite> | ||
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