Arrhythmia - implantable cardioverter defibrillators (ICDs) (review)

Summary

This appraisal does not cover the use of implantable defibrillators for non-ischaemic dilated cardiomyopathy.

ICDs are recommended for patients in the following categories.

'Secondary prevention', that is, for patients who present, in the absence of a treatable cause, with one of the following:

• having survived a cardiac arrest due to either ventricular tachycardia (VT) or ventricular fibrillation (VF)
• spontaneous sustained VT causing syncope or significant haemodynamic compromise
• sustained VT without syncope or cardiac arrest, and who have an associated reduction in ejection fraction (LVEF of less than 35%) (no worse than class III of the New York Heart Association functional classification of heart failure).

'Primary prevention', that is, for patients who have:

a history of previous (more than 4 weeks) myocardial infarction (MI) and:

• either
  • left ventricular dysfunction with an LVEF of less than 35% (no worse than class III of the New York Heart Association functional classification of heart failure), and
  • non-sustained VT on Holter (24-hour electrocardiogram [ECG]) monitoring, and
  • inducible VT on electrophysiological (EP) testing
• or
  • left ventricular dysfunction with an LVEF of less than 30% (no worse than class III of the New York Heart Association functional classification of heart failure) and
  • QRS duration of equal to or more than 120 milliseconds

a familial cardiac condition with a high risk of sudden death, including long QT syndrome, hypertrophic cardiomyopathy, Brugada syndrome or arrhythmogenic right ventricular dysplasia (ARVD), or have undergone surgical repair of congenital heart disease.

This guidance replaces TA11 Arrhythmias - implantable cardioverter defibrillators (ICDs)

Documents

For healthcare professionals

• TA95 Arrhythmia - implantable cardioverter defibrillators (ICDs): Quick reference guide
• TA95 Arrhythmia - implantable cardioverter defibrillators (ICDs): Guidance (Word)
• TA95 Guidance

For patients, carers and the public

• TA95 Arrhythmia - implantable cardioverter defibrillators (ICDs) (no.95): Information for the public

Background information

• 2006/003 NICE guidance set to increase the number of patients receiving life-saving implantable-cardioverter defibrillators
• TA95 Arrhythmia - implantable cardioverter defibrillators (ICDs): Distribution list

Implementing this guidance

Any further information NICE has produced to help the NHS implement this guideline locally is linked to below:

• Arrhythmia - implantable cardioverter defibrillators (ICDs) (review): Implementation advice
• Arrhythmia - implantable cardioverter defibrillators (ICDs): Analysis of cost impact