What are the recommendations for recommending automatic implantable cardioverter-defibrillators (AICDs) for patients with non-ischemic and ischemic heart failure (IHF)?

ACC (American College of Cardiology)/AHA (American Heart Association) guidelines for the evaluation and management of chronic heart failure.  J Am Coll Cardiol 2005 Sep 20;46(6):e1-82

Stage B

“Placement of an ICD is reasonable in patients with ischemic cardiomyopathy who are at least 40 days post-MI (myocardial infarction), have an left ventricular ejection fraction (LVEF) of 30% or less, are NYHA functional class I on chronic optimal medical therapy, and have reasonable expectation of survival with a good functional status for more than 1 year. (Level of Evidence: B)”

“Placement of an ICD might be considered in patients without HF who have nonischemic cardiomyopathy and an LVEF less than or equal to 30% who are in New York Heart Association (NYHA) Functional Classification I with chronic optimal medical therapy and have a reasonable expectation of survival with good functional status for more than 1 year. (Level of Evidence: C)”

Stage C

“An implantable cardioverter-defibrillator is recommended as secondary prevention to prolong survival in patients with current or prior symptoms of HF and reduced LVEF who have a history of cardiac arrest, ventricular fibrillation, or hemodynamically destabilizing ventricular tachycardia. (Level of Evidence: A)

Implantable cardioverter-defibrillator therapy is recommended for primary prevention to reduce total mortality by a reduction in sudden cardiac death in patients with ischemic heart disease who are at least 40 days post-MI, have an LVEF less than or equal to 30%, with NYHA Functional Classification II or III symptoms while undergoing chronic optimal medical therapy, and have reasonable expectation of survival with a good functional status for more than 1 year. (Level of Evidence: A)

Implantable cardioverter-defibrillator therapy is recommended for primary prevention to reduce total mortality by a reduction in sudden cardiac death in patients with nonischemic cardiomyopathy who have an LVEF less than or equal to 30%, with NYHA Functional Classification II or III symptoms while undergoing chronic optimal medical therapy, and who have reasonable expectation of survival with a good functional status for more than 1 year. (Level of Evidence: B)”

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To find out what the levels of evidence are in ACC/AHA guidelines, see “Levels of Evidence” section in ACC/AHA Clinical Practice Guidelines: Part I–Where Do They Come From?  Circulation. 2003;107(23): 2979-86.

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Meta-analysis of RCTs on use of ICDs in patients with non-ischemic cardiomyopathy:
Desai AS, et al. Implantable defibrillators for the prevention of mortality in patients with nonischemic cardiomyopathy: a meta-analysis of randomized controlled trials. JAMA. 2004;292(23):2874-9.

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Summary of the recommendations relevant to AICDs can be found in
DynaMed Plus.  Go to the reviews and guidelines section in the entry for ICD. For a review of evidence on the addition of a pacemaker in these patients, go to the Addition of Pacing section.

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About Amy

Clinical Informationist at EUH Branch Library
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