Congestive heart failure implantation of intracardiac defibrillator: Difference between revisions

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==Indications for an Intracardiac Defibrillator==
==Indications for an Intracardiac Defibrillator==


1. The [[left ventricular ejection fraction]] ([[LVEF]]) is ≤ 35%
1. The [[left ventricular ejection fraction]] ([[LVEF]]) is ≤ 35% <ref name="pmid15659722">{{cite journal |author=Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, Troutman C, Anderson J, Johnson G, McNulty SE, Clapp-Channing N, Davidson-Ray LD, Fraulo ES, Fishbein DP, Luceri RM, Ip JH |title=Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure |journal=[[The New England Journal of Medicine]] |volume=352 |issue=3 |pages=225–37 |year=2005 |month=January |pmid=15659722 |doi=10.1056/NEJMoa043399 |url=http://dx.doi.org/10.1056/NEJMoa043399 |accessdate=2012-04-03}}</ref>


'''''and'''''
'''''and'''''
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2. There is a prior history of [[myocardial infarction]] ([[MI]])
2. There is a prior history of [[myocardial infarction]] ([[MI]]) <ref name="pmid11907286">{{cite journal |author=Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML |title=Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction |journal=[[The New England Journal of Medicine]] |volume=346 |issue=12 |pages=877–83 |year=2002 |month=March |pmid=11907286 |doi=10.1056/NEJMoa013474 |url=http://dx.doi.org/10.1056/NEJMoa013474 |accessdate=2012-04-03}}</ref>


===Background===
===Background===

Revision as of 03:05, 4 April 2012

Congestive Heart Failure Microchapters

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Medical Therapy:

Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
Diuretics
ACE Inhibitors
Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
Nitrates
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Antiarrhythmic Drugs
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Associated conditions

Exercise Training

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Ultrafiltration
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
Cardiac Transplantation

ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

Special Populations
Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

Congestive heart failure implantation of intracardiac defibrillator On the Web

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Editor(s)-In-Chief: James Chang, M.D., Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School [1] and C. Michael Gibson, M.S., M.D. [2], Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School

Overview

  • 50% of heart failure patients die of sudden cardiac death.
  • ICDs are indicated for patients with previous myocardial infarction and LVEF <30%, sustained ventricular tachycardia, inducible ventricular tachycardia.
  • Morbidity/mortality benefit of ICD placement vs. anti-arrhythmic drug therapy is controversial.

Indications for an Intracardiac Defibrillator

1. The left ventricular ejection fraction (LVEF) is ≤ 35% [1]

and

2. NYHA class II/III

OR

1. The left ventricular ejection fraction (LVEF) is ≤ 30%

and

2. There is a prior history of myocardial infarction (MI) [2]

Background

  • ICD implantation has NOT been demonstrated to prolong life in patients who are severely symptomatic or otherwise profoundly debilitated (NYHA class IV).

References

  1. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, Troutman C, Anderson J, Johnson G, McNulty SE, Clapp-Channing N, Davidson-Ray LD, Fraulo ES, Fishbein DP, Luceri RM, Ip JH (2005). "Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure". The New England Journal of Medicine. 352 (3): 225–37. doi:10.1056/NEJMoa043399. PMID 15659722. Retrieved 2012-04-03. Unknown parameter |month= ignored (help)
  2. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML (2002). "Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction". The New England Journal of Medicine. 346 (12): 877–83. doi:10.1056/NEJMoa013474. PMID 11907286. Retrieved 2012-04-03. Unknown parameter |month= ignored (help)


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