Feature | May 13, 2014

Expert Consensus Statement Attempts To Close Gap On ICD Guidance for Specific Populations

May 13, 2014 — The Heart Rhythm Society (HRS), American College of Cardiology (ACC) and American Heart Association (AHA) released Expert Consensus Statement on the Use of Implantable Cardioverter Defibrillator Therapy in Patients Who Are Not Included or Not Well Represented in Clinical Trials at Heart Rhythm 2014, the 35th annual scientific sessions of HRS. The expert consensus statement provides first-of-its-kind guidance on ICD therapy for the management of patient populations who are not well represented in clinical trials and, as a result, not specifically included in existing guidelines.

ICDs have emerged as an important treatment option for patients who are at risk of sudden cardiac arrest, and are very effective for stopping life-threatening abnormal heart rhythms. However, while ICD therapy has been proven beneficial in many patient populations, there remain scenarios where clinicians are often asked to make decisions regarding ICD therapy for patients who fall outside of existing guidelines.

"Without exception, guidelines help clinicians make important decisions when it comes to ICD therapy; however, we must continue to refine our understanding of who benefits from ICD implantation in order to optimize patient care," said task force chair and lead author of the statement, Fred M. Kusumoto, M.D., FHRS, the Mayo Clinic in Jacksonville, Fla. "Because guidelines are mainly determined by the outcomes of large clinical trials, smaller patient populations or unique circumstances are typically not provided with indications for treatment. This document will serve as a new guide for clinicians so that many more, if not all, patients receive the right treatment at the right time."

The members of the writing group performed a comprehensive literature search, and then developed a series of recommendations with an explanation of the reasoning and research used to make each recommendation. The writing group also evaluated the available data on important situations for which ICD therapy might be beneficial in selected populations.

The expert consensus statement includes specific recommendations for the following four situations:

  1. Use of an ICD in patients with an abnormal troponin that is not due to a myocardial infarction (MI);
  2. Use of an ICD within 40 days after a MI;
  3. Use of an ICD within the first 90 days after revascularization; and
  4. Use of an ICD in the first nine months after initial diagnosis of nonischemic cardiomyopathy.

Additionally, the writing group evaluated the utility of an atrial lead in a patient requiring ICD therapy without cardiac resynchronization therapy (CRT). The statement provides recommendations for specific scenarios where CRT is not indicated or not desired and a clinician must decide between a single- or dual-chamber ICD. Specific scenarios, including but not limited to those with AV block, Long QT syndrome, and persistent or permanent AF, are outlined with atrial lead use noted as either recommended, not recommended, can be useful or may be considered.

The recommendations aim to help improve consistency and overall quality among hospitals and healthcare providers. Initiatives that standardize data elements and define best practices are critical for leveraging the benefits of ICD therapy to large populations. Future research should continue to evaluate the effectiveness and value of ICD therapy.

The consensus statement was developed in collaboration with and endorsed by the Heart Failure Society of America (HFSA) and the Society of Thoracic Surgeons (STS). It was endorsed by the European Heart Rhythm Association (EHRA), Asia Pacific Heart Rhythm Society (APHRS) and Latin American Society of Cardiac Pacing and Electrophysiology, and will be published in the July 2014 edition of HeartRhythm.

For more information: www.hrsonline.org

Related Content

iRhythm Technologies, ZIO continuous cardiac monitoring service, myZIO app, irregular heartbeat symptoms, reporting

Image courtesy of iRhythm Technologies

Technology | ECG Monitoring Services| November 19, 2015
iRhythm Technologies Inc. announced the launch of new patient engagement tools to enhance the diagnosis of cardiac...
wearable Holter monitors, iRhythm, ziopatch, zio patch

iRhythm Technologies Zio Patch was among the first of a new generation of simplified, wearable Holter monitors designed to increase ease of use and patient compliance to increase detection of arrhythmias that may lead to stroke.

Feature | Holter Monitoring Systems| November 16, 2015 | Judy Lenane, RN, MHA
One-third of ischemic strokes are classified as cryptogenic.
Medtronic, Micra TPS, Global Clinical Trial, results

Image courtesy of Medtronic

News | Pacemakers| November 11, 2015
 Medtronic plc announced that the Medtronic Micra Transcatheter Pacing System (TPS) was successfully implanted in...
LivaNova, Platinum, ICD, CRT-D, launch, Europe and Japan

Image courtesy of LivaNova PLC

News | Implantable Cardioverter Defibrillators (ICD)| November 04, 2015
LivaNova PLC, formerly Sorin Group, launched Platinum, a new range of implantable cardiac defibrillators (ICDs) and...
StopAfib.org, atrial fibrillation, AF-related stroke, patient engagement materials

Infographic courtesy of StopAfib.org

News | Stroke| November 03, 2015
In recognition of World Stroke Day, the patient-focused organization StopAfib.org launched a diverse set of materials...
News | Heart Failure| November 02, 2015
Medical device developer Cardionomic Inc. announced that it has received $20 million in Series A financing. Investors...
Boston Scientific, CE Mark, MRI conditional labeling, CRT-Ds, ICDs

X4 CRT-D system image courtesy of Boston Scientific

News | EP Lab| October 30, 2015
Boston Scientific Corp. has received CE Mark on magnetic resonance imaging (MRI) conditional labeling for the current...
Stereotaxis, Niobe remote magnetic navigation system, respiratory compensation, cardiac ablation
Technology | Robotic Systems| October 28, 2015
Stereotaxis Inc. announced the worldwide launch of Respiratory Compensation, a new software feature of the company’s...
Praxbind, Pradaxa reversal agent, FDA approval, emergency situations
Technology | Antiplatelet and Anticoagulation Therapies| October 19, 2015
The U.S. Food and Drug Administration (FDA) granted accelerated approval to Praxbind (idarucizumab) for use in patients...
AtriCure, definitive merger agreement, nContact Inc., atrial fibrillation solutions, cardiac ablation
News | Ablation Systems| October 14, 2015
AtriCure Inc. announced it has entered into a definitive merger agreement under which AtriCure has agreed to acquire...
Overlay Init