Medicine review
ICD indications
ICDs in hard failure, the general principles involve a state that the primary low injection fraction awards a secondary prevention considerations, and then primary prevention devices considered appropriate only after three months of optimal medical therapy or three months of post-reascularization or 40 days after MI. Patients should have expected longevity of more than a year or consideration for VAD, ventricular assist device or transplant caution for patients with NYHA4, not expected to improve and CCS-1217 hard failure guidelines more prevalently used. You can also add CRT to the ICD. So in summary, the indications include a schematic cardiomyopathy, a non-schemic cardiomyopathy, with the ejection fraction of less than 30, which is a strong recommendation and ejection fraction of 31 to 35% is a weak recommendation. And also, the hard failure guidelines include NYHA Class 2-4, ejection fraction of less than 35, NYHA Class 1, with left to go to ejection fraction of less than 30, or NYHA Class 2-3, with ejection fraction of less than 35. So ICD-4 secondary prevention is for a schematic and non-schemic population. Number one indication is, obviously these indications have a caveat that they have to be non-reversible. Obviously, if there are reversible causes of these arrhythmias and obviously there is no need for ICD. So if the cause is irreversible, then the first indication is cardiac arrest, Vt or Vf. Number two is sustained Vt in the presence of significant structural heart disease. Number three is sustained Vt for more than 48 hours post-Ami. So the ICD systems can be of two times trans venous, which is most common, lead through subclamin, vein into the RV and can pace in Dfib. Number two of the ICD systems is subcutaneous. The device sits in the axalo and there's lower risk of venous stenosis and endocarditis. A shorter battery life and useful for younger patients and does not pace. So it's just the ICD and it's not a pacing, cannot act as a pacing device. [BLANK_AUDIO]