Congestive heart failure implantation of intracardiac defibrillator: Difference between revisions

	Congestive Heart Failure Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology Systolic Dysfunction Diastolic Dysfunction HFpEF HFrEF
Causes
Differentiating Congestive heart failure from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Clinical Assessment
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
Cardiac MRI
Echocardiography
Exercise Stress Test
Myocardial Viability Studies
Cardiac Catheterization
Other Imaging Studies
Other Diagnostic Studies
Treatment
Invasive Hemodynamic Monitoring
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 Hydralazine Positive Inotropics Anticoagulants Angiotensin Receptor-Neprilysin Inhibitor Antiarrhythmic Drugs Nutritional Supplements Hormonal Therapies Drugs to Avoid Drug Interactions Treatment of underlying causes 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
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Congestive heart failure implantation of intracardiac defibrillator
CDC on Congestive heart failure implantation of intracardiac defibrillator
Congestive heart failure implantation of intracardiac defibrillator in the news
Blogs on Congestive heart failure implantation of intracardiac defibrillator
Directions to Hospitals Treating Congestive heart failure implantation of intracardiac defibrillator
Risk calculators and risk factors for Congestive heart failure implantation of intracardiac defibrillator

VisualWikitext

Revision as of 03:02, 4 April 2012

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%

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)

Background

ICDs prevent sudden death in appropriately selected patients with heart failure and left ventricular systolic dysfunction irrespective of etiology.

Implantation of an ICD for primary prevention of sudden death should be considered for patients with LVEF ≤ 35% who are in NYHA functional class II or III.

ICD implantation is not appropriate or beneficial for patients in NYHA class IV (severely debilitated). In post-MI patients, implantation of an ICD should be performed no earlier than 40 days post-MI in patients with persistent moderate or severe left ventricular systolic dysfunction: LVEF ≤ 30% for asymptomatic (NYHA class I) patients or LVEF ≤ 35% for symptomatic (NYHA class II or III) patients.

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

References

Template:WikiDoc Sources

@@ Line 29: / Line 29: @@
 *Implantation of an [[ICD]] for primary prevention of sudden death should be considered for patients with [[LVEF]] ≤ 35% who are in [[New york heart association functional classification|NYHA functional class II or III]].
-*[[ICD]] implantation is not appropriate or beneficial for patients in [[New york heart association functional classification|NYHA class IV]] (severely debilitated).
+*[[ICD]] implantation is not appropriate or beneficial for patients in [[New york heart association functional classification|NYHA class IV]] (severely debilitated). In post-[[MI]] patients, implantation of an [[ICD]] should be performed no earlier than 40 days post-MI in patients with persistent moderate or severe [[left ventricular systolic dysfunction]]: [[LVEF]] ≤ 30% for asymptomatic ([[New york heart association functional classification|NYHA class I]]) patients or [[LVEF]] ≤ 35% for symptomatic ([[New york heart association functional classification|NYHA class II or III]]) patients.
-:*In post-[[MI]] patients, implantation of an [[ICD]] should be performed no earlier than 40 days post-MI in patients with persistent moderate or severe [[left ventricular systolic dysfunction]]:
-::*[[LVEF]] ≤ 30% for asymptomatic ([[New york heart association functional classification|NYHA class I]]) patients or [[LVEF]] ≤ 35% for symptomatic ([[New york heart association functional classification|NYHA class II or III]]) patients.
 *[[ICD]] implantation has NOT been demonstrated to prolong life in patients who are severely symptomatic or otherwise profoundly debilitated ([[New york heart association functional classification|NYHA class IV]]).