Implantable cardioverter defibrillators and cardiac resynchronisation therapy for arrhythmias and heart failure

  • Technology appraisal guidance
  • TA314
  • Published: 
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1 Recommendations

This guidance replaces NICE's technology appraisal guidance 95 on implantable cardioverter defibrillators for arrhythmias and NICE's technology appraisal guidance 120 on cardiac resynchronisation therapy for the treatment of heart failure.

1.1

Implantable cardioverter defibrillators (ICDs) are recommended as options for:

  • treating people with previous serious ventricular arrhythmia, that is, people who, without a treatable cause:

    • have survived a cardiac arrest caused by either ventricular tachycardia (VT) or ventricular fibrillation or

    • have spontaneous sustained VT causing syncope or significant haemodynamic compromise or

    • have sustained VT without syncope or cardiac arrest, and also have an associated reduction in left ventricular ejection fraction (LVEF) of 35% or less but their symptoms are no worse than class 3 of the New York Heart Association (NYHA) functional classification of heart failure.

  • treating people who:

    • have a familial cardiac condition with a high risk of sudden death, such as long QT syndrome, hypertrophic cardiomyopathy, Brugada syndrome or arrhythmogenic right ventricular dysplasia or

    • have undergone surgical repair of congenital heart disease.

1.2

Implantable cardioverter defibrillators (ICDs), cardiac resynchronisation therapy (CRT) with defibrillator (CRT‑D) or CRT with pacing (CRT‑P) are recommended as treatment options for people with heart failure who have left ventricular dysfunction with a left ventricular ejection fraction (LVEF) of 35% or less as specified in table 1.

Table 1 Treatment options with ICD or CRT for people with heart failure who have left ventricular dysfunction with an LVEF of 35% or less (according to NYHA class, QRS duration and presence of LBBB)

-

NYHA class 1 NYHA class 2 NYHA class 3 NYHA class 4
QRS interval <120 milliseconds

ICD if there is a high risk of sudden cardiac death

ICD if there is a high risk of sudden cardiac death

ICD if there is a high risk of sudden cardiac death

ICD and CRT not clinically indicated
QRS interval 120 to 149 milliseconds without LBBB

ICD

ICD

ICD

CRT‑P

QRS interval 120 to 149 milliseconds with LBBB

ICD

CRT‑D

CRT‑P or CRT‑D

CRT‑P

QRS interval ≥150 milliseconds with or without LBBB

CRT‑D

CRT-D

CRT‑P or CRT‑D

CRT‑P

CRT-D, cardiac resynchronisation therapy with defibrillator; CRT-P, cardiac resynchronisation therapy with pacing; ICD, implantable cardioverter defibrillators; LBBB, left bundle branch block; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association