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Secondary Prevention ICD Indication — EECC MCQ

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EasyCardiac DevicesSecondary Prevention ICD IndicationEECC

A 60-year-old man with ischaemic cardiomyopathy and LVEF 18% presents with an episode of sustained polymorphic VT degenerating into VF. He is resuscitated. Coronary angiography shows chronic three-vessel disease with CABG grafts all patent. CMR shows extensive transmural LGE in the anterior and inferior walls (40% of LV mass). Is ICD implantation indicated?

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Correct answer: C — ICD is indicated as secondary prevention (Class I) — all cardiac arrest survivors with a reversible cause NOT identified should receive an ICD; the extensive scar serves as the arrhythmogenic substrate making recurrence highly likely

Secondary prevention ICD implantation is a Class I recommendation for survivors of cardiac arrest due to VF/VT not attributable to a completely reversible cause (e.g. acute MI within 48 hours, severe electrolyte disturbance, drug toxicity). This patient's cardiac arrest occurred in the context of chronic ischaemic cardiomyopathy with extensive scar — the arrhythmogenic substrate is permanent and recurrence risk is high (30-50% at 2 years without ICD). The AVID, CIDS, and CASH trials established the mortality benefit of ICD for secondary prevention. The 2022 ESC VA/SCD Guidelines recommend ICD for virtually all VF/VT cardiac arrest survivors with preserved life expectancy >1 year and acceptable functional status. Catheter ablation of the VT substrate should also be considered to reduce ICD shock burden.

Reference: ESC (2022): VA/SCD Guidelines; AVID/CIDS/CASH Trials