Продолжение.
2. ИКД (имплантируемы кардиовертер-дефибриллятор).
Ниже показания к его имплантации.
ACC/AHA/HRS Guidelines for Device-Based Therapy
Recommendations for Implantable Cardioverter Defibrillators
Перевод ниже, перевел не все, а только по теме, перевод выделен красным шрифтом.
CLASS I
1. ICD therapy is indicated in patients who are survivors of cardiac
arrest due to VF or hemodynamically unstable sustained VT after
evaluation to define the cause of the event and to exclude any
completely reversible causes. (Level of Evidence: A) (16,319–324)
2. ICD therapy is indicated in patients with structural heart disease
and spontaneous sustained VT, whether hemodynamically stable
or unstable. (Level of Evidence: B) (16,319–324)
3. ICD therapy is indicated in patients with syncope of undetermined
origin with clinically relevant, hemodynamically significant
sustained VT or VF induced at electrophysiological study.
(Level of Evidence: B) (16,322)
4. ICD therapy is indicated in patients with LVEF less than or equal to
35% due to prior MI who are at least 40 days post-MI and are in
NYHA functional Class II or III. (Level of Evidence: A) (16,333)
5. ICD therapy is indicated in patients with nonischemic DCM who
have an LVEF less than or equal to 35% and who are in NYHA
functional Class II or III. (Level of Evidence: B) (16,333,369,379)
6. ICD therapy is indicated in patients with LV dysfunction due to
prior MI who are at least 40 days post-MI, have an LVEF less than
or equal to 30%, and are in NYHA functional Class I. (Level of
Evidence: A) (16,332)
7. ICD therapy is indicated in patients with nonsustained VT due to
prior MI, LVEF less than or equal to 40%, and inducible VF or
sustained VT at electrophysiological study. (Level of Evidence:
B) (16,327,329)
CLASS IIa
1. ICD implantation is reasonable for patients with unexplained
syncope, significant LV dysfunction, and nonischemic DCM.
(Level of Evidence: C)
2. ICD implantation is reasonable for patients with sustained VT
and normal or near-normal ventricular function. (Level of Evidence:
C)
3. ICD implantation is reasonable for patients with HCM who have
1 or more major† risk factors for SCD. (Level of Evidence: C)
4. ICD implantation is reasonable for the prevention of SCD in
patients with ARVD/C who have 1 or more risk factors for SCD.
(Level of Evidence: C)
5. ICD implantation is reasonable to reduce SCD in patients with
long-QT syndrome who are experiencing syncope and/or VT while
receiving beta blockers. (Level of Evidence: B) (349–354)
6. ICD implantation is reasonable for non hospitalized patients
awaiting transplantation. (Level of Evidence: C)
7. ICD implantation is reasonable for patients with Brugada syndrome
who have had syncope. (Level of Evidence: C)
8. ICD implantation is reasonable for patients with Brugada syndrome
who have documented VT that has not resulted in cardiac
arrest. (Level of Evidence: C)
9. ICD implantation is reasonable for patients with catecholaminergic
polymorphic VT who have syncope and/or documented
sustained VT while receiving beta blockers. (Level of Evidence: C)
10. ICD implantation is reasonable for patients with cardiac sarcoidosis,
giant cell myocarditis, or Chagas disease. (Level of
Evidence: C)
CLASS IIb
1. ICD therapy may be considered in patients with nonischemic
heart disease who have an LVEF of less than or equal to 35% and
who are in NYHA functional Class I. (Level of Evidence: C)
2. ICD therapy may be considered for patients with long-QT syndrome
and risk factors for SCD. (Level of Evidence: B) (16,349–354)
3. ICD therapy may be considered in patients with syncope and
advanced structural heart disease in whom thorough invasive
and noninvasive investigations have failed to define a cause.
(Level of Evidence: C)
4. ICD therapy may be considered in patients with a familial
cardiomyopathy associated with sudden death. (Level of Evidence:
C)
5. ICD therapy may be considered in patients with LV noncompaction.
(Level of Evidence: C)
CLASS III
1. ICD therapy is not indicated for patients who do not have a
reasonable expectation of survival with an acceptable functional
status for at least 1 year, even if they meet ICD implantation
criteria specified in the Class I, IIa, and IIb recommendations
above. (Level of Evidence: C)
2. ICD therapy is not indicated for patients with incessant VT or VF.
(Level of Evidence: C)
3. ICD therapy is not indicated in patients with significant psychiatric
illnesses that may be aggravated by device implantation or
that may preclude systematic follow-up. (Level of Evidence: C)
4. ICD therapy is not indicated for NYHA Class IV patients with
drug-refractory congestive heart failure who are not candidates
for cardiac transplantation or CRT-D. (Level of Evidence: C)
5. ICD therapy is not indicated for syncope of undetermined cause
in a patient without inducible ventricular tachyarrhythmias and
without structural heart disease. (Level of Evidence: C)
6. ICD therapy is not indicated when VF or VT is amenable to
surgical or catheter ablation (e.g., atrial arrhythmias associated
with the Wolff-Parkinson-White syndrome, RV or LV outflow tract
VT, idiopathic VT, or fascicular VT in the absence of structural
heart disease). (Level of Evidence: C)
7. ICD therapy is not indicated for patients with ventricular tachyarrhythmias
due to a completely reversible disorder in the
absence of structural heart disease (e.g., electrolyte imbalance,
drugs, or trauma). (Level of Evidence: B) (16)
Это действующее руководство по инплантации ИКД.
Перевод выделенного:
Класс 1 - строго обязательно.
5. Имплантация ИКД показана пациентам с неишемической ДКМП кто имеет ФВ менее или равно 35% и у кого функциональный класс СН по NYHA 2-3.
Класс 2 А (т.е. целесообразно: лучше сделать, чем не делать)
Класс 2 Б (нецелесообразно, т.е. лучше не делать).
Класс 3 - делать этого не нужно.
Т.е. Вашему отцу нужен ИКД.
Несмотря на то, что речь о неустойчивой и бессимптомной ЖТ.
Неустойчивая - менее 30 сек.
Для информации - классификация ЖТ (сожалею, но только на английском):
[Изображения доступны только зарегистрированным пользователям]
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