Implantable cardioverter defibrillators for arrhythmias

NICE technology appraisals [TA95] Published date:

This guidance has been replaced by TA314 Arrhythmias - ICDs & Heart failure - cardiac resynchronisation

This guidance updates and replaces NICE technology appraisal 11 (published in September 2000)

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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