ST elevation myocardial infarction implantable cardioverter defibrillator

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Implantable cardioverter-defibrillator is recommended among patients with nonischemic dilated cardiomyopathy or ischemic heart disease at least 40 days following myocardial infarction (MI) with left ventricular ejection fraction (LVEF) of 35% and symptomatic heart failure on chronic guideline-directed medical therapy (GDMT) in order to prevent sudden cardiac death and decrease mortality.

2013 ACCF/AHA Guideline for the Management of Heart Failure (DO NOT EDIT)

Class I

"1. Implantable cardioverter-defibrillator (ICD) therapy is recommended for primary prevention of sudden cardiac death to reduce total mortality in selected patients with nonischemic dilated cardiomyopathy or ischemic heart disease at least 40 days post-MI with LVEF of 35% or less and NYHA class II or III symptoms on chronic guideline-directed medical therapy (GDMT), who have reasonable expectation of meaningful survival for more than 1 year. (Level of Evidence: A)"

"2. ICD therapy is recommended for primary prevention of sudden cardiac death to reduce total mortality in selected patients at least 40 days post-MI with LVEF of 30% or less and NYHA class I symptoms while receiving GDMT, who have reasonable expectation of meaningful survival for more than 1 year. (Level of Evidence: B)"

Class IIa

"1. To prevent sudden death, placement of an ICD is reasonable in patients with asymptomatic ischemic cardiomyopathy who are at least 40 days post-MI, have an LVEF of 30% or less, are on appropriate medical therapy, and have reasonable expectation of survival with a good functional status for more than 1 year. (Level of Evidence: B)"

Class IIb

"1. The usefulness of implantation of an ICD is of uncertain benefit to prolong meaningful survival in patients with a high risk of nonsudden death as predicted by frequent hospitalizations, advanced frailty, or comorbidities such as systemic malignancy or severe renal dysfunction. (Level of Evidence: B)"