Congestive heart failure implantation of intracardiac defibrillator

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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%

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

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