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7.4.1. ICDs and CRTs
COR LOE
Recommendations
1 A 1. In patients with nonischemic DCM or ischemic heart disease
at least 40 days post-MI with LVEF ≤35% and NYHA class
II or III symptoms on chronic GDMT, who have reasonable
expectation of meaningful survival for >1 year, ICD therapy is
recommended for primary prevention of SCD to reduce total
mortality.
Value Statement:
High Value (A)
2. A transvenous ICD provides high economic value in the
primary prevention of SCD particularly when the patient's
risk of death caused by ventricular arrythmia is deemed
high and the risk of nonarrhythmic death (either cardiac or
noncardiac) is deemed low based on the patient's burden of
comorbidities and functional status.
1 B-R 3. In patients at least 40 days post-MI with LVEF ≤30% and
NYHA class I symptoms while receiving GDMT, who have
reasonable expectation of meaningful survival for >1 year,
ICD therapy is recommended for primary prevention of SCD
to reduce total mortality.
1 B-R 4. For patients who have LVEF ≤35%, sinus rhythm, left
bundle branch block (LBBB) with a QRS duration ≥150
ms, and NYHA class II, III, or ambulatory IV symptoms on
GDMT, CRT is indicated to reduce total mortality, reduce
hospitalizations, and improve symptoms and QOL.
Value Statement:
High Value
(B-NR)
5. For patients who have LVEF ≤35%, sinus rhythm, LBBB
with a QRS duration of ≥150 ms, and NYHA class II, III,
or ambulatory IV symptoms on GDMT, CRT implantation
provides high economic value.
2a B-R 6. For patients who have LVEF ≤35%, sinus rhythm, a non-
LBBB pattern with a QRS duration ≥150 ms, and NYHA
class II, III, or ambulatory class IV symptoms on GDMT,
CRT can be useful to reduce total mortality, reduce
hospitalizations, and improve symptoms and QOL.
2a B-R 7. In patients with high-degree or complete heart block and
LVEF of 36% to 50%, CRT is reasonable to reduce total
mortality, reduce hospitalizations, and improve symptoms
and QOL.
7.4. Device and Interventional Therapies for HFrEF
