Congestive heart failure implantation of intracardiac defibrillator
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; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [3]
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
OR
1. The left ventricular ejection fraction (LVEF) is ≤ 30%
and
2. There is a prior history of myocardial infarction (MI) [2]
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).
ACC/AHA Guidelines- Implantable Cardioverter Defibrillator Recommendation [3][4]
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Class I1. An implantable cardioverter defibrillator is recommended as secondary prevention to prolong survival in patients with current or prior symptoms of heart failure and reduced left ventricular ejection fraction (LVEF) who have a history of cardiac arrest, ventricular fibrillation, or hemodynamically destabilizing ventricular tachycardia.[5][6][1] (Level of Evidence: A) 2. Implantable cardioverter defibrillator therapy is recommended for primary prevention of sudden cardiac death to reduce total mortality in patients with non-ischemic dilated cardiomyopathy or ischemic heart disease at least 40 days post-myocardial infarction, a left ventricular ejection fraction (LVEF) less than or equal to 35%, and NYHA functional class II or III symptoms while receiving chronic optimal medical therapy, and who have reasonable expectation of survival with a good functional status for more than 1 year.[7][1][8][9][10][2][11][12] (Level of Evidence: A) |
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Vote on and Suggest Revisions to the Current Guidelines
Guidelines Resources
- The ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult [3]
- 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation [4]
References
- ↑ 1.0 1.1 1.2 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) - ↑ 2.0 2.1 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) - ↑ 3.0 3.1 Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202
- ↑ 4.0 4.1 Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967
- ↑ Bokhari F, Newman D, Greene M, Korley V, Mangat I, Dorian P (2004). "Long-term comparison of the implantable cardioverter defibrillator versus amiodarone: eleven-year follow-up of a subset of patients in the Canadian Implantable Defibrillator Study (CIDS)". Circulation. 110 (2): 112–6. doi:10.1161/01.CIR.0000134957.51747.6E. PMID 15238454. Retrieved 2012-04-05. Unknown parameter
|month=ignored (help) - ↑ Mark DB, Nelson CL, Anstrom KJ, Al-Khatib SM, Tsiatis AA, Cowper PA, Clapp-Channing NE, Davidson-Ray L, Poole JE, Johnson G, Anderson J, Lee KL, Bardy GH (2006). "Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)". Circulation. 114 (2): 135–42. doi:10.1161/CIRCULATIONAHA.105.581884. PMID 16818817. Retrieved 2012-04-05. Unknown parameter
|month=ignored (help) - ↑ 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, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW (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". Journal of the American College of Cardiology. 51 (21): e1–62. doi:10.1016/j.jacc.2008.02.032. PMID 18498951. Retrieved 2012-04-05. Unknown parameter
|month=ignored (help) - ↑ Hebert K, McKinnie J, Horswell R, Arcement L, Stevenson L (2006). "Expansion of heart failure device therapy into a rural indigent population in Louisiana: potential economic and health policy implications". Journal of Cardiac Failure. 12 (9): 689–93. doi:10.1016/j.cardfail.2006.08.214. PMID 17174229. Retrieved 2012-04-05. Unknown parameter
|month=ignored (help) - ↑ Knight BP, Goyal R, Pelosi F, Flemming M, Horwood L, Morady F, Strickberger SA (1999). "Outcome of patients with nonischemic dilated cardiomyopathy and unexplained syncope treated with an implantable defibrillator". Journal of the American College of Cardiology. 33 (7): 1964–70. PMID 10362200. Retrieved 2012-04-05. Unknown parameter
|month=ignored (help) - ↑ Klein HU, Reek S (2000). "The MUSTT study: evaluating testing and treatment" (PDF). Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing. 4 Suppl 1: 45–50. PMID 10590488. Retrieved 2012-04-05. Unknown parameter
|month=ignored (help) - ↑ Hohnloser SH, Connolly SJ, Kuck KH, Dorian P, Fain E, Hampton JR, Hatala R, Pauly AC, Roberts RS, Themeles E, Gent M (2000). "The defibrillator in acute myocardial infarction trial (DINAMIT): study protocol". American Heart Journal. 140 (5): 735–9. PMID 11054618. Retrieved 2012-04-05. Unknown parameter
|month=ignored (help) - ↑ Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H, Kutalek SP, Sharma A (2002). "Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial". JAMA : the Journal of the American Medical Association. 288 (24): 3115–23. PMID 12495391. Retrieved 2012-04-05. Unknown parameter
|month=ignored (help)