Congestive heart failure implantation of intracardiac defibrillator: Difference between revisions
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*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]]. | *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. | ||
*[[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]]). | *[[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]]). | ||
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
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).