GUIDELINES FOR INSERTION OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS

AMERICAN COLLEGE OF CARDIOLOGY, AMERICAN HEART ASSOCIATION, AND HEART RHYTHM SOCIETY GUIDELINES FOR INSERTION OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS

Class I Heart Failure:

• Survivors of cardiac arrest due to VF (ventricular fibrillation) or sustained VT (ventricular tachycardia) after excluding reversible causes

• Patients with structural heart disease and spontaneous, sustained VT, whether hemodynamically stable or unstable

• Patients with syncope of undetermined origin with clinically relevant sustained VT or VF induced at electrophysiology study

• Patients with an LVEF ≤35% due to prior MI occurring at least 40 days earlier and who have NYHA functional class II or III disease

• Patients with nonischemic dilated cardiomyopathy who have an LVEF ≤35% and NYHA functional class II or III disease

• Patients with LV dysfunction due to prior MI occurring at least 40 days earlier with an LVEF ≥30% and who have NYHA class I disease

• Patients with nonsustained VT due to prior MI with an LVEF ≤40% with inducible VF or sustained VT at electrophysiology study

Class IIa Heart Failure

• Patients with unexplained syncope, LV dysfunction, and nonischemic cardiomyopathy

• Patients with sustained VT and normal LV function

• Patients with hypertrophic cardiomyopathy and at least one risk factor for sudden cardiac death

• Patients with arrhythmogenic RV dysplasia with at least one risk factor for sudden cardiac death

• Patients with long QT syndrome with syncope and/or sustained VT while on β-blockers

• Nonhospitalized patients awaiting heart transplantation

• Patients with Brugada syndrome who have syncope or those with documented VT not resulting in cardiac arrest

• Patients with catecholaminergic polymorphic VT who have syncope and/or documented sustained VT while receiving β-blockers

• Patients with cardiac sarcoidosis, giant cell myocarditis or Chagas disease

Class IIb Heart Failure

• Patients with nonischemic heart disease who have an LVEF ≤35% and who have NYHA class I disease

• Patients with long QT syndrome and risk factors for sudden cardiac death

• Patients with syncope and structural heart disease when evaluation has failed to define a cause

• Patients with familial cardiomyopathy associated with sudden cardiac death

• Patients with LV noncompaction

Class III Heart Failure

• ICD implantation not indicated for patients whose reasonable life expectancy at an acceptable functional status is <1 year even if they meet other criteria

Therapeutic Indications by Functional Class

• Class I: There is evidence or general agreement that the treatment is useful and effective.

• Class IIa: Weight of the data or evidence favors benefit of the therapy.

• Class IIb: The conditions for which usefulness or efficacy of the treatment are less well established.

• Class III: Intervention is not indicated.