ICD

Question 1

ICD indications in HCM

Answer 1

HCM Risk-SCD score > 6% : IIa
HCM Risk-SCD score between 4 and 6% : IIb

Question 2

ICD indications in primary prevention in ARVC

Answer 2

□ ICD im­plan­ta­tion should be con­sid­ered in pa­tients with def­i­nite ARVC and an ar­rhyth­mic syn­cope.

□ ICD im­plan­ta­tion should be con­sid­ered in pa­tients with def­i­nite ARVC and se­vere RV or LV sys­tolic dys­func­tion.

□ ICD im­plan­ta­tion should be con­sid­ered in symp­tomat­icb pa­tients with def­i­nite ARVC, mod­er­ate right or left ven­tric­u­lar dys­func­tion, and ei­ther NSVT or in­ducibil­i­ty of SMVT at PES.

Question 3

Long QT syndrome and primary prevention

Answer 3

♡ LQTS + syncope
♡ Asymptomatic + KCNH2 (Romano ward syndrome) or SCN5A (LQTS3) mutations + QTc > 500ms

Question 4

Primary prevention ICD in CAD

Answer 4

● If LVEF =< 35%
○ if NYHA >=2 : ICD (class I)
○ if EF =< 30 : ICD class IIa

● If LVEF 36-40% or if 31-35% asymptomatic then :
○ look for NSVT or unexplained syncope
If present : PES
If SMVT inducible : ICD IIa
If not but syncope : ILR

Question 5

SCD pre­ven­tion in car­diac sar­coido­sis

Answer 5

○ aborted cardiac arrest / SMVT or EF=<35% : ICD class I
○ indication for permanent pacing
○ significant LGE 22% or 9/22 segments
○ EF 35-50% : PES if SMVT inducible : ICD

Question 6

ICD programming

Answer 6

1. In sin­gle-​ or dual-​cham­ber ICD pa­tients with­out brady­car­dia pac­ing in­di­ca­tions, it is rec­om­mend­ed to min­i­mize ven­tric­u­lar pac­ing.
2. Pro­gram­ming of pro­longed de­tec­tion set­tings is in­di­cat­ed (du­ra­tion cri­te­ria of at least 6–12 sec or 30 in­ter­vals).
3. It is rec­om­mend­ed to pro­gram the slow­est tachy­car­dia ther­a­py zone lim­it ≥188 bpm in pri­ma­ry pre­ven­tion ICD pa­tients.
4. In pa­tients with SHD, pro­gram­ming of at least one ATP ther­a­py is rec­om­mend­ed in all tach­yarrhyth­mias zones.
5. It is rec­om­mend­ed to pro­gram al­go­rithms for SVT ver­sus VT dis­crim­i­na­tion for tachy­car­dias with rates up to 230 bpm.
6. It is rec­om­mend­ed to ac­ti­vate lead fail­ure alerts.
7. Re­mote mon­i­tor­ing is rec­om­mend­ed to re­duce the in­ci­dence of in­ap­pro­pri­ate shocks.
8. Pro­gram­ming of burst ATP as first at­tempt is rec­om­mend­ed over ramp ATP.

Question 7

ICD in patients with DCM/HNDCM

Answer 7

First you need CMR
If specific cause : treat it first (inflammatory disease)
Family history and genetic testing

○ If pathogenic mutation LMNA :
5 year risk score of VA > 10% and EF<50% or NSVT or AV conduction delay then ICD IIa

○ Else :
If EF =<35% ICD implantation
EF 36-50% + if >= 2 risk factors (unexplained syncope - inducible SMVT - LGE on CMR - certain mutations) then ICD implantation
If unexplained syncope then ILR and PES