733
edits
ICD indications: Difference between revisions
Jump to navigation
Jump to search
no edit summary
No edit summary |
|||
| (13 intermediate revisions by the same user not shown) | |||
| Line 1: | Line 1: | ||
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> | ||
| Line 14: | Line 12: | ||
* 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> | ||
| Line 23: | Line 24: | ||
* 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> | ||
* | * 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> | ||
| Line 30: | Line 31: | ||
* 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 > | * 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)== | ||
* 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== | ||
| Line 43: | Line 50: | ||
#ESCSCD pmid=16935866 | #ESCSCD pmid=16935866 | ||
#ESCHF pmid=22828712 | #ESCHF pmid=22828712 | ||
#ESCsyncope pmid=19713422 | |||
#ESCfocusedup pmid=20801924 | |||
#ESCHCM pmid=25173338 | |||
</biblio> | </biblio> | ||