Implantable Cardioverter-Defibrillator (ICD)
Key Points
����The options for management of patients with ventricular arrhythmias
include antiarrhythmic agents, catheter ablation, and surgery.
����Patient selection, device and lead implantation, follow-up, and
replacement are parts of a complex process that requires familiarity
with device capabilities, adequate case volume, continuing education,
and skill in the management of ventricular arrhythmias, thus
mandating appropriate training and credentialing.
Treatment
����ICD therapy is indicated in patients:
������ who are survivors of cardiac arrest due to ventricular fibrillation (VF) or
hemodynamically unstable sustained VT after evaluation to define the cause of the
event and to exclude any completely reversible causes. (I-A)
������ with structural heart disease and spontaneous sustained VT, whether
hemodynamically stable or unstable. (I-B)
������ with syncope of undetermined origin with clinically relevant, hemodynamically
significant sustained VT or VF induced at electrophysiological study. (I-B)
������ with LVEF ���35% due to prior MI who are ���40 days post-MI and are in NYHA
functional class II or III. (I-A)
������ with nonischemic dilated cardiomyopathy (DCM) who have an LVEF ���35% and
who are in NYHA functional class II or III. (I-B)
������ with LV dysfunction due to prior MI who are ���40 days post-MI, have an LVEF ���
���30%, and are in NYHA functional class I. (I-A)
������ with nonsustained VT due to prior MI, LVEF ���40%, and inducible VF or
sustained VT at electrophysiological study. (I-B)
����ICD implantation is reasonable:
������ for patients with unexplained syncope, significant LV dysfunction, and
nonischemic DCM. (IIa-C)
������ for patients with sustained VT and normal or near-normal ventricular function.
(IIa-C)
������ for patients with HCM who have ���1 major risk factors for SCD. (IIa-C)
������ for the prevention of SCD in patients with arrhythmogenic right ventricular (RV)
dysplasia/cardiomyopathy who have ���1 risk factors for SCD. (IIa-C)
������ to reduce SCD in patients with long-QT syndrome who are experiencing syncope
and/or VT while receiving beta blockers. (IIa-B)
������ for nonhospitalized patients awaiting transplantation. (IIa-C)
������ for patients with Brugada syndrome who have had syncope. (IIa-C)
������ for patients with Brugada syndrome who have documented VT that has not
resulted in cardiac arrest. (IIa-C)
������ for patients with catecholaminergic polymorphic VT who have syncope and/or
documented sustained VT while receiving beta blockers. (IIa-C)
������ for patients with cardiac sarcoidosis, giant cell myocarditis, or Chagas disease.
(IIa-C)
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