NICE guidance - implantable cardioverter defibrillators
NICE guidance has stated which patients should be considered for the use of implantable cardioverter defibrillators (ICD) include (1):
Implantable cardioverter defibrillators (ICDs) are recommended as options for:
- treating people with previous serious ventricular arrhythmia, that is, people who, without a treatable cause:
- have survived a cardiac arrest caused by either ventricular tachycardia (VT) or ventricular fibrillation or
- have spontaneous sustained VT causing syncope or significant haemodynamic compromise or
- have sustained VT without syncope or cardiac arrest, and also have an associated reduction in left ventricular ejection fraction (LVEF) of 35% or less but their symptoms are no worse than class III of the New York Heart Association (NYHA) functional classification of heart failure
- have survived a cardiac arrest caused by either ventricular tachycardia (VT) or ventricular fibrillation or
- treating people who:
- have a familial cardiac condition with a high risk of sudden death, such as long QT syndrome, hypertrophic cardiomyopathy, Brugada syndrome or arrhythmogenic right ventricular dysplasia or
- have undergone surgical repair of congenital heart disease
- have a familial cardiac condition with a high risk of sudden death, such as long QT syndrome, hypertrophic cardiomyopathy, Brugada syndrome or arrhythmogenic right ventricular dysplasia or
Implantable cardioverter defibrillators (ICDs), cardiac resynchronisation therapy (CRT) with defibrillator (CRT-D) or CRT with pacing (CRT-P) are recommended as treatment options for people with heart failure who have left ventricular dysfunction with a left ventricular ejection fraction (LVEF) of 35% or less as specified in table below:
- Treatment options with ICD or CRT for people with heart failure who have left ventricular dysfunction with an LVEF of 35% or less (according to NYHA class, QRS duration and presence of LBBB)
QRS interval | NYA class I | NYA class II | NYA class III | NYA class IV |
<120 milliseconds | ICD if there is a high risk of sudden cardiac death | ICD if there is a high risk of sudden cardiac death | ICD if there is a high risk of sudden cardiac death | ICD and CRT not clinically indicated |
120- 149 milliseconds without LBBB | ICD | ICD | ICD | CRT-P |
120-149 milliseconds with LBBB | ICD | CRT-D | CRT-P or CRT-D | CRT-P |
>=150 milliseconds with or without LBBB | CRT-D | CRT-D | CRT-P or CRT-D | CRT-P |
LBBB, left bundle branch block; NYHA, New York Heart Association
The NICE guidance does not cover the use of implantable defibrillators for non-ischaemic dilated cardiomyopathy.
Notes:
- subcutaneous implantable cardioverter defibrillator (2)
- current evidence on the efficacy of the insertion of a subcutaneous implantable cardioverter defibrillator (ICD) for the prevention of sudden cardiac death in the short and medium term is adequate
- an entirely subcutaneous ICD differs from a conventional ICD in that the lead is placed subcutaneously, rather than transvenously
- the lead comprises 2 sensing electrodes and a shocking coil
- the ICD senses cardiac signals, but the lead is not directly attached to the heart
- unlike a conventional ICD, the subcutaneous device is not designed to provide long-term pacing
- current evidence on the efficacy of the insertion of a subcutaneous implantable cardioverter defibrillator (ICD) for the prevention of sudden cardiac death in the short and medium term is adequate
Reference:
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