Electrophysiology Testing and the Use of Devices in Heart Failure
General Considerations
Recommendation
It is recommended that the decision to undertake electrophysiologic (EP) intervention, including implantable cardioverter defibrillator (ICD) implantation, be made in light of functional status and prognosis based on severity of underlying HF and comorbid conditions. If an ICD is considered due to left ventricular (LV) dysfunction which is of recent onset, LV function should be reassessed, ideally after 3-6 months of optimal medical therapy. (Strength of Evidence = C)
Background
Trials supporting the use of EP devices in HF for prevention of sudden cardiac death (SCD) typically have excluded patients with persistent New York Heart Association (NYHA) IV HF, patients in cardiogenic shock, those with irreversible brain damage, and those with comorbidities and an expected survival of <1 year. Recent trials have excluded patients with a recent myocardial infarction (MI), a coronary revascularization procedure within 3 months or ongoing ischemia.1 This allows adequate time from the index ischemic event for the appropriate application of pharmacologic therapy and for the beneficial effects of the primary therapeutic strategy to be manifest before consideration of device therapy. Patients are not good candidates for device implantation if they have significant psychiatric illness that may be aggravated by device implantation or are not expected to be compliant with systematic follow-up.