Which Patient and when Should Receive an ICD? Evolving New Indications on the Horizon
Internal cardioverter defibrillator (ICD) therapy has come a long way since its introduction in the 1980s as the first-line treatment for the few fortunate survivors of recurrent sudden cardiac arrest (SCA). Secondary- and primary-prevention trials enrolling patients with either ischemic or nonischemic cardiomyopathy with depressed left ventricular ejection fraction (LVEF) and NYHA II–IV (AVID, CIDS, CASH, MADIT, MUSTT, MADIT II, DEFINITE) have overwhelmingly demonstrated that ICD therapy reduces total mortality compared with anti-arrhythmic drug therapy and/or optimal medical therapy [1, 2, 3, 4, 5, 6, 7]. The most recent trials (COMPANION and SCD-HeFT) [8, 9] focused on patients with NYHA class II–IV heart-failure (HF) symptoms and depressed LVEF: ICD alone or combined with a left ventricular lead for cardiac resynchronization significantly reduced total mortality as compared with optimal medical therapy (ACE inhibitors/ARB blockers, beta-blockers, canrenoate, diuretics) and amiodarone.
KeywordsLeft Ventricular Ejection Fraction Brugada Syndrome Sudden Cardiac Arrest Left Ventricular Lead Implantable Defibrillator
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- 8.Bristow MR, Saxon LA, Boehmer J et al; Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure (COMPANION) investigators (2004) Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 350:2140–2150PubMedCrossRefGoogle Scholar
- 10.Zipes DP, Camm AJ, Borggrefe M et al (2006) ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: 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. Circulation 114:1088–1132CrossRefGoogle Scholar
- 11.Lunati M, Bongiorni MG, Boriani G et al (2005) Linee Guida AIAC 2006 all’impianto di pacemaker, dispositivi per la resincronizzazione cardiaca (CRT) e defibrillatori automatici impiantabili (ICD). Giornale Italiano di Aritmologia e Cardiostimolazione 8(4)Google Scholar