An update on implantable cardioverter-defibrillator guidelines

This review describes changes in indications for implantable cardioverter-defibrillator (ICD) implantation made in the American College of Cardiology, American Heart Association, and North American Society of Pacing and Electrophysiology 2002 update of the 1998 guideline for the implantation of cardiac pacemakers and antiarrhythmia devices.

Recent observational and clinical data support changes in the guidelines for ICD implantation to include patients with no structural heart disease and spontaneous ventricular tachycardia not amenable to other treatments; left ventricular ejection fractions of 0.30 or less at least 1 month after myocardial infarction and at least 3 months after coronary revascularization surgery (the Multicenter Automatic Defibrillator Implantation Trial II); syncope of unexplained origin or a family history of unexplained sudden cardiac death in association with typical or atypical right bundle branch block and ST-segment elevations (Brugada syndrome); and syncope in the setting of advanced structural heart disease when thorough invasive and noninvasive investigations have failed to define a cause.

With the completion of multiple important randomized clinical trials, the application of ICD technology continues to evolve. Indications have expanded from secondary to primary prevention. Most importantly, currently available data support the prophylactic use of ICDs in patients with coronary artery disease and poor left ventricular function. Further trial data are awaited to determine if the same benefits for survival and quality of life will be afforded to patients with nonischemic heart diseases and poor left ventricular function.