0521779407-C02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53
326 Chronic Heart Failure➣Indication: Atrial arrhythmias, symptomatic ventricular arrhyth-
mias (consider AICD)
➣Side Effects and Complications: arrhythmias, SA and AV block,
hepatic failure, severe pulmonary toxicity, corneal deposits; blue-
gray skin discoloration, peripheral neuropathy, ataxia, edema,
dizziness, hyper/hypothyroidism
➣Absolute Contraindications: Severe SA node disease, 2nd/3rd-
degree AV block, sick sinus syndrome, bradycardia-induced syn-
cope
➣Relative Contraindications: Thyroid disease, pulmonary disease,
impaired liver or renal function, elderly
■Device Therapy
■Implantable Cardioverter Defibrillators (ICD): Improve survival in
selected patients; multiple guidelines and indications; decision must
be individualized
➣Indications: Secondary prevention of sudden death with no
known reversible causes; primary prevention in patients with:
Class II or III heart failure+LVEF≤35% OR
Prior MI LVEF≤30% OR
Prior MI LVEF≤35%+inducible sustained VT or VF
➣Contraindications:
Cardiogenic shock or symptomatic hypotension
NIDCM with symptoms <3 months
CABG or PTCA within the past 3 months
Acute MI within the past 40 days
Candidate for coronary revascularization
Irreversible brain damage from preexisting cerebral disease
Noncardiac disease with a likely survival <1 year
➣Side Effects and Complications: Acute: infection and local wound
complications, myocardial perforation with pericardial tampon-
ade, VT/VF induced during testing. Chronic: Infection, inappro-
priate shocks, system failure (leads, generator).
■Biventricular pacemakers (BiV )/Cardiac Resynchronization Ther-
apy (CRT): Reduce CHF hospitalizations and improve survival in
selected patients; multiple guidelines and indications; decision must
be individualized
➣Indications: Patients with symptomatic Class III–IV heart failure
despite stable, optimal heart failure drug therapy AND LV ejection
fraction≤0.35 AND QRS≥120 milliseconds
➣Contraindications: As above for ICD; must be individualized
➣Side Effects and Complications: Acute: infection and local wound