Table 1

An outline of NICE and ESC guidance on the use of ICD for primary prevention

NICE guidance (2006)10ESC guidance (2006)5NICE guidance (2014)11
Primary MI (more than 4 weeks) AND;
Either
LVEF ≤35% (no worse than NYHA III) and
Non-sustained VT on holter (24 h) and
Inducible VT (EPS)
OR
LVEF <30% and
QRS >120 ms		Primary MI (at least 40 days post-MI) AND
LVEF ≤35% (NYHA class II or III)
On optimal medical treatment and who have reasonable expectation of survival with a good functional status of more than 1 year		Patients with heart failure who have LVEF ≤35%
AND;
NYHA class I–III symptoms, and a QRS duration of <120 ms
*ICD if there is a high risk of sudden cardiac death
Or
NYHA class I-III symptoms and a QRS duration of 120–149 ms without LBBB
Or
NYHA class I symptoms
and a QRS duration of 120–149 ms with LBBB
(NYHA class II-III consider CRT-D)
Or
NYHA class I-III symptoms and a QRS duration ≥150 ms with LBBB or no LBBB consider CRT-D

  • *ICD if there is a high risk of sudden cardiac death—these may include: age, sex, degree of left ventricular dysfunction, history of myocardial infarction, presence of cardiomyopathy and a range of other potential prognostic factors like B-type natriuretic peptide.

  • CRT-D, cardiac resynchronisation therapy with defibrillator; EPS, electrophysiology study; ICD, implantable cardioverter defibrillators; LBBB, left bundle branch block; LVEF, left ventricular ejection fraction; MI, myocardial infarction; NICE, National Institute of Health and Care Excellence; NYHA, New York Heart association; VT, ventricular tachycardia. Bold text are key parts of the guidance.