19
YES
YES
YES
YES
ICD concordant with
patient goals of care and
clinical status
ICD concordant with
patient goals of care and
clinical status
NO
NO
NO
Pacemaker
(1)
Pacemaker
(2a)
ICD
(2b)
ICD
(2b)
a
Patients with indications for pacemaker or ICD implantation, including
CRT, based on recommendations from previously published guidelines
are not represented in this flow diagram.
b
Physical examination, ECG, ambulatory ECG, and cardiac imaging
(echocardiography or CMR) at diagnosis with periodic retesting.
c
e purpose of EP testing for risk stratification of sudden death is to assess
integrity of AV conduction, in particular, the His-Purkinje system with
measurement of the HV interval, as well as to determine inducibility
of clinically significant VAs. A suggested stimulation protocol used in
DM1 patients has been published,* and other protocols primarily used in
patients with ischemic heart disease may also be useful. e discussion of
device implantation should be carried out prior to EP testing to confirm
the patient's preference and willingness to undergo CIED implantation.
d
Mild to moderate conduction disorder is defined as PR interval 200–240
ms and/or QRS duration 100–120 ms.
e
Noninvasive testing includes 12-lead ECG, telemetry recordings,
ambulatory ECG, or insertable loop recorder.
Colors correspond to the class of recommendation (COR) on pages 48–49.
* Lazarus A, Varin J, Ounnoughene Z, et al. Circulation 1999;99:1041–1046.
