Arrhythmia - implantable cardioverter defibrillators (ICDs) (review)

This appraisal does not cover the use of implantable defibrillators for non-ischaemic dilated cardiomyopathy. ICDs are recommended for patients in the following categories. 'Secondary prevention', that is, for patients who present, in the absence of a treatable cause, with one of the following: ...

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This appraisal does not cover the use of implantable defibrillators for non-ischaemic dilated cardiomyopathy.

ICDs are recommended for patients in the following categories.

'Secondary prevention', that is, for patients who present, in the absence of a treatable cause, with one of the following:

• having survived a cardiac arrest due to either ventricular tachycardia (VT) or ventricular fibrillation (VF)
• spontaneous sustained VT causing syncope or significant haemodynamic compromise
• sustained VT without syncope or cardiac arrest, and who have an associated reduction in ejection fraction (LVEF of less than 35%) (no worse than class III of the New York Heart Association functional classification of heart failure).

'Primary prevention', that is, for patients who have:

a history of previous (more than 4 weeks) myocardial infarction (MI) and:

• either
  • left ventricular dysfunction with an LVEF of less than 35% (no worse than class III of the New York Heart Association functional classification of heart failure), and
  • non-sustained VT on Holter (24-hour electrocardiogram [ECG]) monitoring, and
  • inducible VT on electrophysiological (EP) testing
• or
  • left ventricular dysfunction with an LVEF of less than 30% (no worse than class III of the New York Heart Association functional classification of heart failure) and
  • QRS duration of equal to or more than 120 milliseconds

a familial cardiac condition with a high risk of sudden death, including long QT syndrome, hypertrophic cardiomyopathy, Brugada syndrome or arrhythmogenic right ventricular dysplasia (ARVD), or have undergone surgical repair of congenital heart disease.

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