Indications Implantable Cardiac Defibrillator (ICD)

1. ICD therapy is indicated in patients who are survivors of cardiac arrest due to ventricular fibrillation or hemodynamically unstable sustained VT after evaluation to define the cause of the event and to exclude any completely reversible causes. (Level of Evidence: A)

2. ICD therapy is indicated in patients with structural heart disease and spontaneous sustained VT, whether hemodynamically stable or unstable. (Level of Evidence: B)

3. ICD therapy is indicated in patients with syncope of undetermined origin with clinically relevant, hemodynamically significant sustained VT or ventricular fibrillation induced at electrophysiological study. (Level of Evidence: B)

4. ICD therapy is indicated in patients with LVEF less than or equal to 35% due to prior myocardial infarction who are at least 40 days post–myocardial infarction and are in NYHA functional Class II or III. (Level of Evidence: A)

5. ICD therapy is indicated in patients with nonischemic dilated cardiomyopathy who have an LVEF less than or equal to 35% and who are in NYHA functional Class II or III. (Level of Evidence: B)

6. ICD therapy is indicated in patients with LV dysfunction due to prior myocardial infarction who are at least 40 days post–myocardial infarction, have an LVEF less than or equal to 30%, and are in NYHA functional Class I. (Level of Evidence: A)

7. ICD therapy is indicated in patients with nonsustained VT due to prior myocardial infarction, LVEF less than or equal to 40%, and inducible ventricular fibrillation or sustained VT at electrophysiological study. (Level of Evidence: B)

Class IIa

1. ICD implantation is reasonable for patients with unexplained syncope, significant LV dysfunction, and nonischemic dilated cardiomyopathy. (Level of Evidence: C)

2. ICD implantation is reasonable for patients with sustained VT and normal or near-normal ventricular function. (Level of Evidence: C)

3. ICD implantation is reasonable for patients with hypertrophic cardiomyopathy who have 1 or more major risk factor for SCD. (Level of Evidence: C)

4. ICD implantation is reasonable for the prevention of SCD in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy who have 1 or more risk factor for SCD. (Level of Evidence: C)

5. ICD implantation is reasonable to reduce SCD in patients with long-QT syndrome who are experiencing syncope and/or VT while receiving beta blockers. (Level of Evidence: B)

6. ICD implantation is reasonable for nonhospitalized patients awaiting transplantation. (Level of Evidence: C)

7. ICD implantation is reasonable for patients with Brugada syndrome who have had syncope. (Level of Evidence: C)

8. ICD implantation is reasonable for patients with Brugada syndrome who have documented VT that has not resulted in cardiac arrest. (Level of Evidence: C)

9. ICD implantation is reasonable for patients with catecholaminergic polymorphic VT who have syncope and/or documented sustained VT while receiving beta blockers. (Level of Evidence: C)

10. ICD implantation is reasonable for patients with cardiac sarcoidosis, giant cell myocarditis, or Chagas disease. (Level of Evidence: C)

Class IIb

1. ICD therapy may be considered in patients with nonischemic heart disease who have an LVEF of less than or equal to 35% and who are in NYHA functional Class I. (Level of Evidence: C)

2. ICD therapy may be considered for patients with long-QT syndrome and risk factors for SCD. (Level of Evidence: B)

3. ICD therapy may be considered in patients with syncope and advanced structural heart disease in whom thorough invasive and noninvasive investigations have failed to define a cause. (Level of Evidence: C)

4. ICD therapy may be considered in patients with a familial cardiomyopathy associated with sudden death. (Level of Evidence: C)

5. ICD therapy may be considered in patients with LV noncompaction. (Level of Evidence: C)

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