The implantable cardioverter defibrillator (ICD) has emerged as an important treatment
option for selected patients who are at risk of sudden cardiac death. Randomized trials
have consistently shown that ICD implantation reduces mortality in patients with heart
failure and reduced left ventricular function, as well as in patients who have suffered
a cardiac arrest.
1
,
2
,
- Moss A.J.
- Zareba W.
- Hall W.J.
- Klein H.
- Wilber D.J.
- Cannom D.S.
- Daubert J.P.
- Higgins S.L.
- Brown M.W.
- Andrews M.L.
for the Multicenter Automatic Defibrillator Implantation Trial II Investigators
Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction.
Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction.
N Engl J Med. 2002; 346: 877-883
3
Recommendations on the use of the ICD in clinical practice have been provided in
four important guideline documents sponsored by the American College of Cardiology
(ACC), the American Heart Association (AHA), Heart Rhythm Society (HRS), and the European
Society of Cardiology (ESC).
4
,
5
,
- Epstein A.E.
- Dimarco J.P.
- Ellenbogen K.A.
- Estes III, N.A.M.
- Freedman R.A.
- Gettes L.S.
- Gillinov A.M.
- Gregoratos G.
- Hammill S.C.
- Hayes D.L.
- Hlatky M.A.
- Newby L.K.
- Page R.L.
- Schoenfeld M.H.
- Silka M.J.
- Stevenson L.W.
- Sweeney M.O.
ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities:
executive summary: a report of the American College of Cardiology/American Heart Association
Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002
Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices)
Developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons.
Developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons.
Heart Rhythm. 2008; 5: 934-955
6
,
- Zipes D.P.
- Camm A.J.
- Borggrefe M.
- Buxton A.E.
- Chaitman B.
- Fromer M.
- Gregoratos G.
- Klein G.
- Moss A.J.
- Myerburg R.J.
- Priori S.G.
- Quinones M.A.
- Roden D.M.
- Silka M.J.
- Tracy C.
ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias
and the prevention of sudden cardiac death—executive summary: a report of the American
College of Cardiology/American Heart Association Task Force and the European Society
of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines
for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden
Cardiac Death)
Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.
Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.
J Am Coll Cardiol. 2006; 48: e247-e346
7
For each indication for ICD therapy, both a Class of indication (I, II, or III) and
level of evidence for the indication (A, B, or C) are provided. To ensure that recommendations
are evidence-based, Class I recommendations are typically based on the results of
prospective randomized clinical trials. For example, in the ACC/AHA/HRS 2012 Focused
Update of the ACC/AHA/HRS 2008 Guidelines on Device-Based Therapy, no new recommendations
on the indications for ICD therapy were made, with the important exception of ICDs
that also provide cardiac resynchronization therapy (CRT-D).
- O’Gara P.T.
- Kushner F.G.
- Ascheim D.D.
- Casey Jr, D.E.
- Chung M.K.
- de Lemos J.A.
- Ettinger S.M.
- Fang J.C.
- Fesmire F.M.
- Franklin B.A.
- Granger C.B.
- Krumholz H.M.
- Linderbaum J.A.
- Morrow D.A.
- Newby L.K.
- Ornato J.P.
- Ou N.
- Radford M.J.
- Tamis-Holland J.E.
- Tommaso C.L.
- Tracy C.M.
- Woo Y.J.
- Zhao D.X.
2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:
a report of the American College of Cardiology Foundation/American Heart Association
Task Force on Practice Guidelines
Developed in collaboration with the American College of Emergency Physicians and Society for Cardiovascular Angiography and Interventions.
Developed in collaboration with the American College of Emergency Physicians and Society for Cardiovascular Angiography and Interventions.
J Am Coll Cardiol. 2013; 61: e78-140
8
The lack of new recommendations reflects the fact that clinical trials over this
period of time have focused on studying the effectiveness of ICDs that provide CRT
therapy and not on the outcomes of non-CRT defibrillators. Randomized clinical trials
study the effects of a particular treatment on a carefully selected and relatively
homogeneous group of patients who meet specific inclusion and exclusion criteria for
a particular clinical trial. Consistent with this approach, the indications for ICD
therapy developed in the various guideline statements are limited to the specific
populations of patients who participated in these clinical trials. Although the resulting
guidelines are of great value, clinicians are often asked to make decisions regarding
ICD therapy in patient populations who were not included or who were poorly represented
in prior clinical trials. For these patients, there are no specific indications for
ICD therapy. The purpose of this consensus statement is to provide clinicians with
guidance on the use of ICD therapy in the management of some common populations of
patients who are not represented in clinical trials and who therefore are not specifically
included in the various guidelines that provide indications for ICD therapy. However,
recommendations made in this document cannot account for all the nuances of clinical
medicine and cannot replace careful clinical judgment for the care of an individual
patient.- Tracy C.M.
- Epstein A.E.
- Darbar D.
- DiMarco J.P.
- Dunbar S.B.
- Estes 3rd, N.A.M.
- Ferguson Jr, T.B.
- Hammill S.C.
- Karasik P.E.
- Link M.S.
- Marine J.E.
- Schoenfeld M.H.
- Shanker A.J.
- Silka M.J.
- Stevenson L.W.
- Stevenson W.G.
- Varosy P.D.
2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of
cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American
Heart Association Task Force on Practice Guidelines. Developed in collaboration with
the American Association for Thoracic Surgery, Heart Failure Society of America, and
Society of Thoracic Surgeons.
Heart Rhythm. 2012; 9: 1737-1753
Keywords
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Publication history
Published online: May 09, 2014
Footnotes
Developed in partnership with and endorsed by the American College of Cardiology (ACC) and the American Heart Association (AHA); and in collaboration with and endorsed by the Heart Failure Society of America (HFSA) and the Society of Thoracic Surgeons (STS). Endorsed by the European Heart Rhythm Association (EHRA), the Asia Pacific Heart Rhythm Society (APHRS) and the Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE)-Latin American Society of Cardiac Pacing and Electrophysiology.
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© 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
