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Arrhythmias
When to consider an implantable cardioverter defibrillator following myocardial infarction?
  1. Benjamin R Szwejkowski1,
  2. Gary A Wright2,
  3. Derek T Connelly2,
  4. Roy S Gardner2
  1. 1Department of Cardiology, Ninewells Hospital and Medical School, Dundee, UK
  2. 2Department of Cardiology, Golden Jubilee National Hospital, Clydebank, UK
  1. Correspondence to Dr Roy S Gardner, Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK; rsgardner{at}doctors.org.uk

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Learning objectives

After reading this article the reader should be familiar with:

  • Current guidelines for implantable cardioverter defibrillator (ICD) use post myocardial infarction (MI) and ischaemic cardiomyopathy.

  • Primary prevention ICD guidelines.

  • Secondary prevention ICD guidelines.

  • Non-sustained ventricular tachycardia in patients post MI and the use of ICDs.

  • Programming ICDs.

Curriculum topic: Arrhythmias Introduction

The implantable cardioverter defibrillator (ICD) is established as an effective therapy for ventricular arrhythmias. It has proven prognostic benefits when used in selected patients with heart failure and those following myocardial infarction (MI), and with an LVEF ≤35%—as both primary and secondary prevention. This article looks at current evidence and guidelines relating to this area; in particular, we focus on current guidelines and how they should be applied to current practice.

What is an ICD?

An ICD system allows treatment of life-threatening heart rhythm problems and an example of a dual-chamber, dual-coil ICD is shown in figure 1A, B.

Figure 1

(A and B) A dual-coil, dual-chamber implantable cardioverter defibrillator in posteroanterior and lateral projections.

Secondary prevention ICDs

The use of ICDs in secondary prevention of ventricular tachycardia (VT) and ventricular fibrillation (VF) apply in the chronic phase after MI. Established guidelines from the European Society of Cardiology (ESC) and the American College of Cardiology recommend their use in haemodynamically unstable VT and VF without a reversible cause regardless of LV function (class I; level A).1 ,2 ICDs convey significant improvements in mortality over and above antiarrhythmic therapy in these patients.3 It is important that patients are selected appropriately; they should have a good quality of life and with an anticipated life expectancy of >1 year (tables 1 and 2).4–6 Arrhythmias occurring in the first 24–48 h due to acute ischaemia do not usually require an ICD. However, in patients who have had an episode of ‘early’ sustained VT or VF, if the LVEF remains low in the …

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