1 Guidance
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This guidance replaces NICE technology appraisal guidance 95 issued in January 2006 and NICE technology appraisal guidance 120 issued in May 2007. |
1.1 Implantable cardioverter defibrillators (ICDs) are recommended as options for:
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treating people with previous serious ventricular arrhythmia, that is, people who, without a treatable cause:
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have survived a cardiac arrest caused by either ventricular tachycardia (VT) or ventricular fibrillation or
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have spontaneous sustained VT causing syncope or significant haemodynamic compromise or
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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 III of the New York Heart Association (NYHA) functional classification of heart failure.
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treating people who:
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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
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have undergone surgical repair of congenital heart disease.
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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)
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NYHA class |
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QRS interval |
I |
II |
III |
IV |
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<120 milliseconds |
ICD if there is a high risk of sudden cardiac death |
ICD and CRT not clinically indicated |
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120–149 milliseconds without LBBB |
ICD |
ICD |
ICD |
CRT‑P |
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120–149 milliseconds with LBBB |
ICD |
CRT‑D |
CRT‑P or CRT‑D |
CRT‑P |
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≥150 milliseconds with or without LBBB |
CRT‑D |
CRT-D |
CRT‑P or CRT‑D |
CRT‑P |
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LBBB, left bundle branch block; NYHA, New York Heart Association |
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