ICD indications: Difference between revisions

no edit summary
No edit summary
Line 2: Line 2:


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>
Line 17: Line 17:
* 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>
Line 33: Line 33:
* 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)==
* 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 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==