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Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities

Implantable Cardioverter-Defibrillators

Implantable Cardioverter-Defibrillators in Pediatric Patients and Patients With Congenital Heart Disease

Expert Consensus on the Use of Implantable Cardioverter-Defibrillator Therapy in Patients Who Are Not Included or Not Well Represented in Clinical Trials

ICD Implantation in the Context of an Abnormal Troponin that is Not Due to a Myocardial Infarction

ICD Implantation Within 40 Days of a Myocardial Infarction

ICD Implantation Within 90 Days of Revascularization

ICD Implantation Less Than 9 Months From The Initial Diagnosis of Nonischemic Cardiomyopathy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]

2012 ACCF/AHA/HRS Focused Update Incorporated Into the ACCF/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities[1][2]

Class I
"1. ICD therapy is indicated in patients who are survivors of cardiac arrest due to ventricular fibrillation or hemodynamically unstable sustained VT after evaluation to define the cause of the event and to exclude any completely reversible causes.[3][4][5][6][7][8][9] (Level of Evidence: A)"
"2. ICD therapy is indicated in patients with structural heart disease and spontaneous sustained VT, whether hemodynamically stable or unstable.[3][4][5][6][7][8][9] (Level of Evidence: B)"
"3. ICD therapy is indicated in patients with syncope of undetermined origin with clinically relevant, hemodynamically significant sustained VT or ventricular fibrillation induced at electrophysiological study.[3][7] (Level of Evidence: B)"
"4. ICD therapy is indicated in patients with LVEF less than or equal to 35% due to prior myocardial infarction who are at least 40 days post–myocardial infarction and are in NYHA functional Class II or III.[3][10] (Level of Evidence: A)"
"5. ICD therapy is indicated in patients with nonischemic dilated cardiomyopathy who have an LVEF less than or equal to 35% and who are in NYHA functional Class II or III.[3][10][11][12] (Level of Evidence: B)"
"6. ICD therapy is indicated in patients with LV dysfunction due to prior myocardial infarction who are at least 40 days post- myocardial infarction, have an LVEF less than or equal to 30%, and are in NYHA functional Class I.[3][13] (Level of Evidence: A)"
"7. ICD therapy is indicated in patients with nonsustained VT due to prior myocardial infarction, LVEF less than or equal to40%, and inducible ventricular fibrillation or sustained VT at electrophysiological study.[3][14][15] (Level of Evidence: B)"
Class III (No Benefit)
"1. ICD therapy is not indicated for patients who do not have a reasonable expectation of survival with an acceptable functional status for at least 1 year, even if they meet ICD implantation criteria specified in the Class I, IIa, and IIb recommendations above. (Level of Evidence: C)"
"2. ICD therapy is not indicated for patients with incessant VT or ventricular fibrillation. (Level of Evidence: C)"
"3. ICD therapy is not indicated in patients with significant psychiatric illnesses that may be aggravated by device implantation or that may preclude systematic follow-up. (Level of Evidence: C)"
"4. ICD therapy is not indicated for NYHA Class IV patients with drug-refractory congestive heart failure who are not candidates for cardiac transplantation or CRT-D. (Level of Evidence: C)"
"5. ICD therapy is not indicated for syncope of undetermined cause in a patient without inducible ventricular tachyarrhythmias and without structural heart disease. (Level of Evidence: C)"
"6. ICD therapy is not indicated when VF or VT is amenable to surgical or catheter ablation (e.g., 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). (Level of Evidence: C)"
"7. ICD therapy is not indicated for patients with ventricular tachyarrhythmias due to a completely reversible disorder in the absence of structural heart disease (e.g., electrolyte imbalance, drugs, or trauma).[3] (Level of Evidence: B)"
Class IIa
"1. ICD implantation is reasonable for patients with unexplained syncope, significant LV dysfunction, and nonischemic DCM. (Level of Evidence: C)"
"2. ICD implantation is reasonable for patients with sustained VT and normal or near-normal ventricular function. (Level of Evidence: C)"
"3. ICD implantation is reasonable for patients with HCM who have 1 or more major{dagger} risk factors for SCD. (Level of Evidence: C)"
"4. ICD implantation is reasonable for the prevention of SCD in patients with ARVD/C who have 1 or more risk factors for SCD. (Level of Evidence: C)"
"5. ICD implantation is reasonable to reduce SCD in patients with long-QT syndrome who are experiencing syncope and/or VT while receiving beta blockers.[16][17][18][19][20][21] (Level of Evidence: B)"
"6. ICD implantation is reasonable for non hospitalized patients awaiting transplantation. (Level of Evidence: C)"
"7. ICD implantation is reasonable for patients with Brugada syndrome who have had syncope. (Level of Evidence: C)"
"8. ICD implantation is reasonable for patients with Brugada syndrome who have documented VT that has not resulted in cardiac arrest. (Level of Evidence: C)"
"9. ICD implantation is reasonable for patients with catecholaminergic polymorphic VT who have syncope and/or documented sustained VT while receiving beta blockers. (Level of Evidence: C)"
"10. ICD implantation is reasonable for patients with cardiac sarcoidosis, giant cell myocarditis, or Chagas disease. (Level of Evidence: C)"
Class IIb
"1. ICD therapy may be considered in patients with nonischemic heart disease who have an LVEF of less than or equal to 35% and who are in NYHA functional Class I. (Level of Evidence: C)"
"2. ICD therapy may be considered for patients with long-QT syndrome and risk factors for SCD.[3][16][17][18][19][20][21] (Level of Evidence: B)"
"3. ICD therapy may be considered in patients with syncope and advanced structural heart disease in whom thorough invasive and noninvasive investigations have failed to define a cause. (Level of Evidence: C)"
"4. ICD therapy may be considered in patients with a familial cardiomyopathy associated with sudden death. (Level of Evidence: C)"
"5. ICD therapy may be considered in patients with LV noncompaction. (Level of Evidence: C)"
  1. Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes NA, Ferguson TB, Hammill SC, Karasik PE, Link MS, Marine JE, Schoenfeld MH, Shanker AJ, Silka MJ, Stevenson LW, Stevenson WG, Varosy PD (2013). "2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society". J. Am. Coll. Cardiol. 61 (3): e6–75. doi:10.1016/j.jacc.2012.11.007. PMID 23265327.
  2. Epstein AE, DiMarco JP, Ellenbogen KA; et al. (2008). "ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons". Circulation. 117 (21): e350–408. PMID 18483207. Text "doi:10.1161/CIRCUALTIONAHA.108.189742 " ignored (help); Unknown parameter |month= ignored (help)
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 European Heart Rhythm Association. Heart Rhythm Society. Zipes DP, Camm AJ, Borggrefe M, Buxton AE; et al. (2006). "ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death)". J Am Coll Cardiol. 48 (5): e247–346. doi:10.1016/j.jacc.2006.07.010. PMID 16949478.
  4. 4.0 4.1 "A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators". N Engl J Med. 337 (22): 1576–83. 1997. doi:10.1056/NEJM199711273372202. PMID 9411221.
  5. 5.0 5.1 Wever EF, Hauer RN, van Capelle FL, Tijssen JG, Crijns HJ, Algra A; et al. (1995). "Randomized study of implantable defibrillator as first-choice therapy versus conventional strategy in postinfarct sudden death survivors". Circulation. 91 (8): 2195–203. PMID 7697849.
  6. 6.0 6.1 Siebels J, Kuck KH (1994). "Implantable cardioverter defibrillator compared with antiarrhythmic drug treatment in cardiac arrest survivors (the Cardiac Arrest Study Hamburg)". Am Heart J. 127 (4 Pt 2): 1139–44. PMID 8160593.
  7. 7.0 7.1 7.2 Connolly SJ, Gent M, Roberts RS, Dorian P, Roy D, Sheldon RS; et al. (2000). "Canadian implantable defibrillator study (CIDS) : a randomized trial of the implantable cardioverter defibrillator against amiodarone". Circulation. 101 (11): 1297–302. PMID 10725290.
  8. 8.0 8.1 Kuck KH, Cappato R, Siebels J, Rüppel R (2000). "Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest : the Cardiac Arrest Study Hamburg (CASH)". Circulation. 102 (7): 748–54. PMID 10942742.
  9. 9.0 9.1 Connolly SJ, Hallstrom AP, Cappato R, Schron EB, Kuck KH, Zipes DP; et al. (2000). "Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials. AVID, CASH and CIDS studies. Antiarrhythmics vs Implantable Defibrillator study. Cardiac Arrest Study Hamburg . Canadian Implantable Defibrillator Study". Eur Heart J. 21 (24): 2071–8. doi:10.1053/euhj.2000.2476. PMID 11102258.
  10. 10.0 10.1 Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R; et al. (2005). "Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure". N Engl J Med. 352 (3): 225–37. doi:10.1056/NEJMoa043399. PMID 15659722. Review in: ACP J Club. 2005 Jul-Aug;143(1):6
  11. Kadish A, Dyer A, Daubert JP, Quigg R, Estes NA, Anderson KP; et al. (2004). "Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy". N Engl J Med. 350 (21): 2151–8. doi:10.1056/NEJMoa033088. PMID 15152060. Review in: ACP J Club. 2004 Nov-Dec;141(3):61
  12. Desai AS, Fang JC, Maisel WH, Baughman KL (2004). "Implantable defibrillators for the prevention of mortality in patients with nonischemic cardiomyopathy: a meta-analysis of randomized controlled trials". JAMA. 292 (23): 2874–9. doi:10.1001/jama.292.23.2874. PMID 15598919. Review in: ACP J Club. 2005 May-Jun;142(3):57
  13. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS; et al. (2002). "Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction". N Engl J Med. 346 (12): 877–83. doi:10.1056/NEJMoa013474. PMID 11907286. Review in: ACP J Club. 2002 Nov-Dec;137(3):81
  14. Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystowsky EN, Hafley G (1999). "A randomized study of the prevention of sudden death in patients with coronary artery disease. Multicenter Unsustained Tachycardia Trial Investigators". N Engl J Med. 341 (25): 1882–90. doi:10.1056/NEJM199912163412503. PMID 10601507.
  15. Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H; et al. (1996). "Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators". N Engl J Med. 335 (26): 1933–40. doi:10.1056/NEJM199612263352601. PMID 8960472.
  16. 16.0 16.1 Zareba W, Moss AJ, Daubert JP, Hall WJ, Robinson JL, Andrews M (2003). "Implantable cardioverter defibrillator in high-risk long QT syndrome patients". J Cardiovasc Electrophysiol. 14 (4): 337–41. PMID 12741701.
  17. 17.0 17.1 Viskin S (2003). "Implantable cardioverter defibrillator in high-risk long QT syndrome patients". J Cardiovasc Electrophysiol. 14 (10): 1130–1, reply 1131. PMID 14521674.
  18. 18.0 18.1 Goel AK, Berger S, Pelech A, Dhala A (2004). "Implantable cardioverter defibrillator therapy in children with long QT syndrome". Pediatr Cardiol. 25 (4): 370–8. doi:10.1007/s00246-003-0566-4. PMID 14994181.
  19. 19.0 19.1 Mönnig G, Köbe J, Löher A, Eckardt L, Wedekind H, Scheld HH; et al. (2005). "Implantable cardioverter-defibrillator therapy in patients with congenital long-QT syndrome: a long-term follow-up". Heart Rhythm. 2 (5): 497–504. doi:10.1016/j.hrthm.2005.02.008. PMID 15840474.
  20. 20.0 20.1 Goldenberg I, Mathew J, Moss AJ, McNitt S, Peterson DR, Zareba W; et al. (2006). "Corrected QT variability in serial electrocardiograms in long QT syndrome: the importance of the maximum corrected QT for risk stratification". J Am Coll Cardiol. 48 (5): 1047–52. doi:10.1016/j.jacc.2006.06.033. PMID 16949500.
  21. 21.0 21.1 Hobbs JB, Peterson DR, Moss AJ, McNitt S, Zareba W, Goldenberg I; et al. (2006). "Risk of aborted cardiac arrest or sudden cardiac death during adolescence in the long-QT syndrome". JAMA. 296 (10): 1249–54. doi:10.1001/jama.296.10.1249. PMID 16968849.