New Zealand primary implantable cardioverter defibrillator implantation and biventricular pacing guidelines.
Primary implantation of an implantable Cardioverter Defibrillator (ICD) is recommended for patients with ischaemic or non-ischaemic cardiomyopathy present for at least 3 months, with ejection fraction (EF) = or <30% measured = or >3 months after optimal heart failure treatment. Patients should be on maximal heart failure treatment as tolerated for = or >3 and preferably 6 months, and in New York Heart Association (NYHA) Class II or III. They should be = or >3 months remote from any revascularisation procedure or have no clinical symptoms or findings that would make them a candidate for revascularisation. There should be no associated disease reducing survival <18 months. Biventricular pacing is recommended for patients with an EF = or <35% after = or >6 weeks of optimal heart failure treatment, whose QRS duration is >149 ms or is 120-149 ms with two additional criteria for dyssynchrony (aortic pre-ejection delay >140 ms, interventricular mechanical delay >40 ms or delayed activation of the posterolateral left ventricular wall). They should be NYHA Class III, have had no major cardiovascular event in the prior 6 weeks and be in sinus rhythm. There should be no major comorbidity reducing survival <18 months or seriously impairing quality of life.
Smith
Warren
W
Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag 92024, Auckland 1030, New Zealand. warrens@adhb.govt.nz
D002304:Cardiac Pacing, Artificial / Q000191:economics / Q000592:standards*; D009202:Cardiomyopathies / Q000628:therapy*; D003362:Cost-Benefit Analysis; D017147:Defibrillators, Implantable / Q000191:economics / Q000592:standards*; D005060:Europe; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D009520:New Zealand; D013318:Stroke Volume; D014481:United States