ACC GUIDELINES Bundle (free trial)

Diagnosis and Treatment ÎÎICD therapy may be considered in patients: •  with nonischemic heart disease who have an LVEF of ≤35% and who are in NYHA functional class I. (IIb-C) •  with long-QT syndrome and risk factors for SCD. (IIb-B) •  with syncope and advanced structural heart disease in whom thorough invasive and noninvasive investigations have failed to define a cause. (IIb-C) •  with a familial cardiomyopathy associated with sudden death. (IIb-C) •  with LV noncompaction. (IIb-C) ÎÎICD therapy is NOT indicated: •  for patients who do not have a reasonable expectation of survival with an acceptable functional status for ≥1 year, even if they meet ICD implantation criteria specified in the Class I, IIa, and IIb recommendations above. (III-C) •  for patients with incessant VT or VF. (III-C) •  for patients with significant psychiatric illnesses that may be aggravated by device implantation or that may preclude systematic follow-up. (III-C) •  for NYHA class IV patients with drug-refractory congestive HF who are not candidates for cardiac transplantation or CRT defibrillator (CRT-D). (III-C) •  syncope of undetermined cause in a patient without inducible ventricular tachyarrhythmias and without structural heart disease. (III-C) •  when VF or VT is amenable to surgical or catheter ablation (eg, atrial arrhythmias associated with the Wolff-Parkinson-White syndrome, RV or LV outflow tract VT, idiopathic VT, or fascicular VT in the absence of structural heart disease). (III-C) •  for patients with ventricular tachyarrhythmias due to a completely reversible disorder in the absence of structural heart disease (eg, electrolyte imbalance, drugs, or trauma). (III-B) Pediatric Patients and Patients With Congenital Heart Disease Note: All Class III recommendations found in Section 3 of the full text guidelines, "Indications for Implantable Cardioverter-Defibrillator Therapy," apply to pediatric patients and patients with congenital heart disease. ICD implantation is not indicated in these patient populations. (III-C) ÎÎICD implantation is indicated: •  in the survivor of cardiac arrest after evaluation to define the cause of the event and to exclude any reversible causes. (I-B) •  for patients with symptomatic sustained VT in association with congenital heart disease who have undergone hemodynamic and electrophysiological evaluation. (I-C) Catheter ablation or surgical repair may offer possible alternatives in carefully selected patients. ÎÎICD implantation is reasonable: •  for patients with congenital heart disease with recurrent syncope of undetermined origin in the presence of either ventricular dysfunction or inducible ventricular arrhythmias at electrophysiological study. (IIa-B) ÎÎICD implantation may be considered: •  for patients with recurrent syncope associated with complex congenital heart disease and advanced systemic ventricular dysfunction when thorough invasive and noninvasive investigations have failed to define a cause. (IIb-C) 12

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