Tachyarrhythmia Management
 

Clinical Guidelines and Indications

Clinical guidelines and indications include ACC and AHA Guidelines for ICD defibrillator therapy to prevent sudden cardiac arrest due to ventricular tachycardia and ventricular fibrillation (VT and VF).

Overview

2012 ACC/AHA/HRS Guidelines for Implantable Defibrillator and Cardiac Resynchronization Therapy for Cardiac Rhythm Abnormalities1 (PDF, 182 KB)

Despite ICD defibrillators and cardiac resynchronization therapy being a Class I or IIa indication for treatment of patients, research confirms underutilization and variation of care in heart failure patients.2,3

References

  1. Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. J Am Coll Cardiol. May 27, 2008;51(21):e1-62.
  2. Fonarow GC, Yancy CW, Albert NM, et al. Heart failure care in the outpatient cardiology practice setting: findings from IMPROVE HF. Circulation:Heart Failure. July 2008;1:98-106.
  3. Piccini JP, Hernandez AF, Dai D, et al. Use of cardiac resynchronization therapy in patients hospitalized with heart failure. Circulation. 2008;118:926-933.

Class I Recommendations for ICD Defibrillators

The Class I recommendations for ICD defibrillators1-3 are listed below. ICD therapy is indicated in patients:*

Level of Evidence – A

  • With LVEF ≤ 35% due to prior MI who are at least 40 days post-MI and are in NYHA Functional Class II or III
  • With LV dysfunction due to prior MI who are at least 40 days post-MI, have an LVEF ≤ 30%, and are in NYHA Functional Class 1
  • Who are survivors of sudden cardiac arrest due to ventricular fibrillation (VF) after evaluation to define the cause of the event and to exclude any completely reversible causes

Level of Evidence – B

  • With nonischemic DCM who have an LVEF ≤ 35% and who are in NYHA Functional Class II or III
  • With nonsustained ventricular tachycardia (VT) due to prior MI, LVEF < 40%, and inducible ventricular fibrillation or sustained ventricular tachycardia at electrophysiological study
  • With structural heart disease and spontaneous sustained VT, whether hemodynamically stable or unstable
  • With syncope of undetermined origin with clinically relevant, hemodynamically significant sustained VT or VF induced at electrophysiological study

* Assuming patients are on chronic, optimal medical therapy and have a reasonable expectation of survival with good functional status for > 1 year.

References

  1. Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. J Am Coll Cardiol. May 27, 2008;51(21):e1-62.
  2. Fonarow GC, Yancy CW, Albert NM, et al. Heart failure care in the outpatient cardiology practice setting: findings from IMPROVE HF. Circulation:Heart Failure. July 2008;1:98-106.
  3. Piccini JP, Hernandez AF, Dai D, et al. Use of cardiac resynchronization therapy in patients hospitalized with heart failure. Circulation. 2008;118:926-933.

Class II Recommendations for ICD Defibrillators

The Class II recommendations for ICD defibrillators1-3 are listed below. ICD implantation is reasonable for patients:*

Level of Evidence – B

  • To reduce sudden cardiac death in patients with Long QT Syndrome who are experiencing syncope and/or ventricular tachycardia while receiving beta blockers

Level of Evidence – C
With unexplained syncope, significant LV dysfunction, and nonischemic DCM

  • With sustained ventricular tachycardia and normal or near-normal ventricular function
  • With catecholaminergic polymorphic VT who have syncope and/or documented sustained VT while receiving beta blockers
  • For the prevention of sudden cardiac death in patients with ARVD/C who have one or more risk factors for sudden cardiac death
  • With HCM who have one or more major risk factors for sudden cardiac death
  • With Brugada syndrome who have had syncope or documented VT that has not resulted in cardiac arrest
  • With cardiac sarcoidosis, giant cell myocarditis, or Chagas disease
  • For nonhospitalized patients awaiting transplantation

* Assuming patients are on chronic, optimal medical therapy and have a reasonable expectation of survival with good functional status for > 1 year.

References

  1. Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. J Am Coll Cardiol. May 27, 2008;51(21):e1-62.
  2. Fonarow GC, Yancy CW, Albert NM, et al. Heart failure care in the outpatient cardiology practice setting: findings from IMPROVE HF. Circulation:Heart Failure. July 2008;1:98-106.
  3. Piccini JP, Hernandez AF, Dai D, et al. Use of cardiac resynchronization therapy in patients hospitalized with heart failure. Circulation. 2008;118:926-933.
Last updated: 21 Aug 2013

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