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Heart Failure: Difference between revisions
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→Timing of ICD implantation
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Figure 5 offers recommendations to which patients should receive ICD treatment. In this flowchart, the timing of the placement has not been defined completely. In most patients, it should be safe to wait for their ICD whilst receiving (pharmalogical) treatment as events typically occur after 6-12 months. <cite>12</cite> In exception to this rule, in high risk patients (i.e. patients with major myocardial infarction (MI), extensive fibrosis on the MRI or NSVT despite optimal pharmalogical treatment), an ICD implantation should not be postponed too long. Early (within 40 days after event) ICD placement after an acute myocardial infarction has not been shown to reduce mortality, because the patients most at risk of sudden death are also the patients most at risk of death due to heart failure. <cite>13</cite><cite>14</cite><cite>15</cite> For this reason, prophylactic ICD treatment is recommended only after 40 days in post-infarct patients who have an EF < 35%. For non-ischemic heart failure patients, three months is considered a safe waiting time for an ICD. There are however also higher risk patients among them, and this should be a decision made for every patient individually.<cite>16</cite> | Figure 5 offers recommendations to which patients should receive ICD treatment. In this flowchart, the timing of the placement has not been defined completely. In most patients, it should be safe to wait for their ICD whilst receiving (pharmalogical) treatment as events typically occur after 6-12 months. <cite>12</cite> In exception to this rule, in high risk patients (i.e. patients with major myocardial infarction (MI), extensive fibrosis on the MRI or NSVT despite optimal pharmalogical treatment), an ICD implantation should not be postponed too long. Early (within 40 days after event) ICD placement after an acute myocardial infarction has not been shown to reduce mortality, because the patients most at risk of sudden death are also the patients most at risk of death due to heart failure. <cite>13</cite><cite>14</cite><cite>15</cite> For this reason, prophylactic ICD treatment is recommended only after 40 days in post-infarct patients who have an EF < 35%. For non-ischemic heart failure patients, three months is considered a safe waiting time for an ICD. There are however also higher risk patients among them, and this should be a decision made for every patient individually.<cite>16</cite> | ||
[[Image: | [[Image:CRT_flowchart.svg|thumb|400px|Figure 8 flowchart CRT]] | ||
===Heart transplantation and Left Ventricular Assist Devices=== | ===Heart transplantation and Left Ventricular Assist Devices=== | ||