Authors' objectives:

To provide guidance on the use of implantable cardioverter defibrillators for arrhythmias.

Authors' recommendations: Guidance 1.1. The use of implantable cardioverter defibrillators (ICDs) should be routinely considered for patients in the following categories: 1.1.1 Secondary prevention i.e. for patients who present, in the absence of a treatable cause, with:- - 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/cardiac arrest, and who have an associated reduction in ejection fraction (less than 35%) but are no worse than class 3 of the New York Heart Association functional classification of heart failure. 1.1.2 Primary prevention for patients (see paragraph 2.5 for definition) with: - a history of previous myocardial infarction (MI) and all of the following: i) non sustained VT on Holter (24 hour ECG) monitoring; ii) inducible VT on electrophysiological testing; iii) left ventricular dysfunction with an ejection fraction (EF) less than 35% and no worse than class III of the New York Heart Association functional classification of heart failure. - a familial cardiac condition with a high risk of sudden death, including long QT syndrome, hypertrophic cardiomyopathy, Brugada syndrome, arrhythmogenic right ventricular dysplasia (ARVD) and following repair of Tetralogy of Fallot. 1.2 The use of implantable cardioverter defibrillators should not be routinely considered for patients in the following categories:- 1.2.1 Those with spontaneous sustained VT associated with minimal symptoms and good cardiac function (EF> 35%). 1.2.2 Those who present with syncope of unknown cause (with no previous history of myocardial infarction) and who have inducible VT on electrophysiological testing (EPS) in the presence of normal cardiac function (EF>35%) 1.3 At this stage, the Institute considers that the evidence for patients with syncope of unknown origin, with haemodynamically significant sustained VT or VF induced at EPS and in the presence of impaired cardiac function (i.e. ejection fraction (EF) <35%) is insufficient to recommend the use of ICDs.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.nice.org.uk/page.aspx?o=TA011

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: National Institute for Clinical Excellence

Contact Address: MidCity Place, 71 High Holborn, London WC1V 6NA, UK. Tel: +44 020 7067 5800; Fax: +44 020 7067 5801

Contact Name: nice@nice.nhs.uk

Contact Email: nice@nice.nhs.uk

Copyright: National Institute for Clinical Excellence (NICE)